SBTW Sponsor Application Form 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 byNumber 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 statusI have a working knowledge of the 12 Steps and Traditions of Narcotics Anonymous* Yes No My knowledge of the steps and traditionsPlease explainNA 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 GuidePlease explainDo you agree to abide by the guidelines of the SBTW subcommittee?* Yes No GuidelinesPlease explainAre you willing to follow a group conscience you disagree with?* Yes No Group ConsciencePlease explainMy 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)?AttendancePlease explainAre you willing to reply to any letter within two weeks of the date you receive a letter from your sponsee?* Yes No Prompt ReplyPlease explainAvailability* 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 AvailabilityPlease explainContent* 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?ContentPlease explainPackages* 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.)?PackagesPlease explainActivities* 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 activitiesPlease explainAre you part of the Southern California Region?* Yes No Meeting RepDoes 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.PhoneThis field is for validation purposes and should be left unchanged.