Complete and fax to 0866-130-131 or email to info@lotsha.org.za

“Coming to a new life”

Going Home Support Application

Please complete the info requested below, using block capitals, and submit to Lotsha as soon as you are aware of an inmate being released. It takes a minimum of 3 months to properly set up a “connection”.

Items with a * must be completed. The others are for office use.

*	Name of Inmate/Releasee
*	Board number/ID
*	Expected date of release
*	Physical Address where he/she will be


*	Name & contact number of person submitting this form. (Not the inmate)	_______________________________________________
	Date received at Lotsha
	Closest Church to above address
	Contact person at above church
	Allocate a “Carer” for follow-up
	Has communication between parties begun
	Final date of release confirmed	Yes/No Date is:
	Community Services reporting office	Name of centre:
	Confirm Release & Contact	Release: Contact:
	3/6/12/18 month follow-up	3: 6: 12: 18:

It is important that the person submitting this form has a personal knowledge of the inmate being recommended. You are requested to submit a short reference on the inmate, as well as details of ALL courses attended while in prison – both spiritual and others. Please also give any other information that may be relevant.

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Yours, In His Service

Lothsa Ministries

Going Home Project