SBTW Sponsor Application Form - Sponsorship Behind The Walls

Your Email*

Your Name*

First Last

Your Address*

Street Address Address Line 2 City State ZIP Code

Your Phone Number*

Your Preferred Pen Name*

First

This will be the name your Sponsee will know you by

Number of Sponsees to Write*

Please enter a number from 1 to 20.

Disclaimer*

Disclaimer

By checking the above box I understand that every letter I send into the facility where my sponsee resides could be opened and checked for contraband. The content of the letter is to remain on topics outlined by the program of Narcotics Anonymous and discretion will be exercised in writing about any matter that could be construed as to jeopardize the safety and the security of the facility, it’s staff, it’s residents, this subcommittee, or anyone else. I understand that failure to adhere to any of the aforementioned articles will result in cessation of my participation in the Southern California Region of Narcotics Anonymous Sponsorship Behind the Walls Subcommittee program and may put the whole program at risk. The Subcommittee will notify me when I am approved as a sponsor and when I have been assigned a sponsee at the appropriate time.

As a Sponsor I Agree to:*

Yes I Agree
No I Do Not

Check above box after reviewing agreement. you must "agree" to submit this application.

1. Limit my contact with sponsee to writing only.
2. Refrain from using abusive or profane language in my correspondence.
3. Respect the confidentiality of my sponsee.
4. Refrain from supplying my sponsee materials including envelops, stamps, pre-stamped envelopes, writing paper, and writing implements.
5. Refrain from sending my sponsee, any books, tapes, or items of this nature.
6. Refrain from supplying my sponsee with my telephone number, address, and any other information prohibited by the program.
7. Refrain from visiting my sponsee or having contact with him/her outside the facility.
8. Refrain from contacting anyone whom my sponsee might ask me to contact.
9. Refrain from revealing any damaging personal information as outlined in our guidelines.
10. Attest to not having been a victim or an accomplice of a crime with someone who is presently incarcerated as a result of that crime.

I have a minimum of 2 years clean*

Yes
No

Clean Time*

If you have less than two (2) years clean tell us why you should be considered for sponsorship.

I have an NA Sponsor and carry a clear NA message*

Yes
No

My Sponsor status

I have a working knowledge of the 12 Steps and Traditions of Narcotics Anonymous*

Yes
No

My knowledge of the steps and traditions

Please explain

NA Step Working Guide*

Yes
No

Are you willing to utilize the NA Step Working Guides as the primary means to work the 12 Steps?

Step Working Guide

Please explain

Do you agree to abide by the guidelines of the SBTW subcommittee?*

Yes
No

Guidelines

Please explain

Are you willing to follow a group conscience you disagree with?*

Yes
No

Group Conscience

Please explain

My Attendance*

Yes
No

Are you willing to attend/report to the SBTW subcommittee meeting by attending the monthly meeting, checking in at the Area meeting or other SBTW event/meeting, or by sending a report (e.g. text, email)?

Attendance

Please explain

Are you willing to reply to any letter within two weeks of the date you receive a letter from your sponsee?*

Yes
No

Prompt Reply

Please explain

Availability*

Yes
No

Do you agree to report to the committee if you are no longer available to be an SBTW sponsor and to pass on any contact information for sponsees who are still active?

My Availability

Please explain

Content*

Yes
No

Do you agree to refrain from using abusive/profane language and to refrain from providing personal telephone numbers, addresses, photos, and any other information that could be construed as to incriminate, implicate, or jeopardize the safety and the security of their facility, its staff, this subcommittee, or anyone else?

Content

Please explain

Packages*

Yes
No

Do you agree not to visit or send anything to your sponsee other than NA-approved literature and letters (e.g. money, food/care packages, no envelopes, stamps, writing paper, writing implements, books, tapes, etc.)?

Packages

Please explain

Activities*

Yes
No

Do you agree not to engage in any activities with the sponsee other than step work by mail (i.e. pen pal, letters to the parole board, contacting people for the sponsee, providing information about outside enterprises)?

Outside activities

Please explain

Are you part of the Southern California Region?*

Yes
No

Meeting Rep

Does your area have a SBTW Rep or will you be attending the Regional SBTW meeting yourself?

What area are you from?

Outside the Region?

Please tell us where you are and what the name of your Area is.

Name

This field is for validation purposes and should be left unchanged.