SOP 106.11-att-1: Special Religious Request Form

Division:
Chaplaincy Services
Effective Date:
May 21, 2025
Reference Code:
VA01-0011
Topic Area:
106 Policy-Chaplaincy
PowerDMS:
View on PowerDMS
Length:
284 words

Summary

This form is used by incarcerated individuals to request exceptions to normal facility allowances for religious purposes, such as special dietary accommodations, religious paraphernalia, literature, headwear, or grooming practices. Requests must include justification based on religious scripture and length of faith commitment. The form requires approval from multiple levels of authority including the facility chaplain, warden, Field Operations Director, Director of Chaplaincy Services, and General Counsel before being granted or denied.

Key Topics

  • religious request
  • religious accommodation
  • religious paraphernalia
  • religious diet
  • religious headwear
  • religious grooming
  • religious medallions
  • religious literature
  • chaplain
  • faith-based request
  • exception to allowances
  • religious practice
  • inmate religious rights

Full Text

SOP 106.11
Attachment 1

05/21/2025
# Special Religious Request

__________________________________

Facility
Nature of Request:

Religious Paraphernalia Personal Grooming Other

Diet (Not Vegan or Restricted Vegan Religious Medallions
Meal Plan. See SOP 409.04.28)
Literature Religious Headwear

Offender Name: ____________________________ ID#: ___________________ Date: ____________

Reason and Justification for exception to normal allowances : Must include length of commitment or involvement
in faith. Must include the religious scripture or reference this request is based upon. ( Any offender proven to be abusing the
rights obtained through this request shall be subject to disciplinary action and rights will be terminated. Do not
complete this form to request regular items already approved for possession such as religious medallions.)
______________________________________________________________________________________________________

______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

___________________________
Offender’s Signature

______________________________________________ Approved/Disapproved (Circle one)
Facility Chaplain (Signature/Date)

______________________________________________ Approved/Disapproved (Circle one)
Warden/ Superintendent (Signature/Date)

______________________________________________ Approved/Disapproved (Circle one)
Field Operations Director/Designee (Signature/Date)

______________________________________________ Approved/Disapproved (Circle one)
Director of Chaplaincy Services (Signature/Date)

______________________________________________ Approved/Disapproved (Circle one)
General Counsel/Designee (Signature/Date)

Comments:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

Retention Schedule: Upon completion, this attachment shall be placed in the offender’s institutional file and the file shall be
maintained according to the official retention schedule for that file.

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RECEIPT FOR SPECIAL REQUEST FORM AT COUNSELOR'S LEVEL:

OFFENDER'S NAME_________________________________ GDC I.D. #: _______________________

I ACKNOWLEDGE RECEIPT OF THE SPECIAL REQUEST FORM FROM THE ABOVE OFFENDER.

DATE: ______/______/_______ COUNSELOR'S SIGNATURE ______________________________

Attachments (1)

  1. Special Religious Request Form (284 words)
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