SOP_NUMBER: 106.11-att-1
TITLE: Special Religious Request Form
REFERENCE_CODE: VA01-0011
DIVISION: Chaplaincy Services
TOPIC_AREA: 106 Policy-Chaplaincy
EFFECTIVE_DATE: 2025-05-21
WORD_COUNT: 284
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/122394
URL: https://gps.press/sop-data/106.11-att-1/

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

ATTACHMENTS:
  1. Special Religious Request Form
     URL: https://gps.press/sop-data/106.11-att-1/

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FULL TEXT:
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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 ______________________________