Liberation Identification Endorsement Form

Do you agree to publicly endorse Liberation Identification, an effort to implement a statewide program providing state-issued photo identification to all people leaving incarceration in Kentucky?*

Yes
Not yet - I'd like to learn more information before committing. Please contact me.

Are you endorsing as a Kentucky resident or on behalf of an organization?*

Resident
Organization

Your Name*

First Last

Your Organization’s Name (as the name should appear in print)*

Email*

Phone Number*

Organization address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

By endorsing Liberation Identification, our organization agrees to allow our logo to appear on the Liberation Identification webpage. Are you authorized to endorse Liberation Identification on behalf of your organization?*

Yes - Our organization endorses Liberation Identification.
No - please contact the individual listed below:

Name*

First Last

Email*

Phone*

Please upload your organization’s logo for display on the Liberation Identification webpage.*

Max. file size: 64 MB.

Your Name*

First Last

Email*

Phone*

Address

Street Address Address Line 2 City State / Province / Region

ZIP / Postal Code Country

By endorsing Liberation Identification, I agree to allow my name to appear on the Liberation Identification webpage.*

Yes
No, I would like to be involved in other ways. Please list them:

List Other Ways You Would Like To Be Involved*

How has this issue impacted you? (Select all that apply)

I was formerly incarcerated and faced reentry without an ID.
I was formerly incarcerated and have been through the experience of reentry.
I have had loved ones affected by incarceration.
I want to advocate for reforms in the criminal legal system.
Other

Other:

Would you be interested in sharing your experiences and insights as a part of the Liberation Identification campaign?

Yes
No

Liberation Identification Endorsement Form

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