SOP_NUMBER: 107.05-att-1
TITLE: Program Data Form (Attachment 1)
REFERENCE_CODE: VB01-0008
DIVISION: Office of Reentry Services
TOPIC_AREA: 107 Policy-Counseling/Risk Reduction
EFFECTIVE_DATE: 2022-05-12
WORD_COUNT: 1483
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/106471
URL: https://gps.press/sop-data/107.05-att-1/
SUMMARY:
This form is used by group facilitators in the Georgia Department of Corrections Office of Reentry Services to track and document participant enrollment and progress in counseling and risk reduction programs. Facilitators must complete the form when starting a new group, recording participant names, GDC identification numbers, start dates, termination dates, termination reasons, and pre/post-test scores. The form is submitted to the Operations Analyst for data entry into the SCRIBE system within seven days.
KEY_TOPICS: program data form, group facilitator, participant tracking, reentry services, counseling programs, risk reduction programs, SCRIBE data entry, pre-test scores, post-test scores, program evaluation, termination codes, transitional centers
ATTACHMENTS:
1. Program Data Form (Attachment 1)
URL: https://gps.press/sop-data/107.05-att-1/
2. Participant Expectation Form
URL: https://gps.press/sop-data/107.05-att-2/
3. Workbook Order Request (MRT, SOPP, Active Parenting)
URL: https://gps.press/sop-data/107.05-att-3/
4. Moral Reconation Therapy (MRT) Workbook Receipt
URL: https://gps.press/sop-data/107.05-att-4/
5. Procedure for Ordering SOPP Materials
URL: https://gps.press/sop-data/107.05-att-5/
6. Sex Offender Psycho-Educational Program (SOPP) Group Contract
URL: https://gps.press/sop-data/107.05-att-6/
7. Sex Offender Psycho-Educational Program (SOPP) Refusal Form
URL: https://gps.press/sop-data/107.05-att-7/
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FULL TEXT:
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SOP 107.05
Attachment 1
5/12/22
Page 1 of 2
|Georgia Department of Corrections Office of Reentry Services PROGRAM DATA FORM|Col2|Col3|Col4|Col5|Col6|Col7|Col8|
|---|---|---|---|---|---|---|---|
|**SITE:**|**SITE:**|**SITE:**|**SITE:**|**SITE:**|**SITE:**|**SITE:**|**SITE:**|
|**FACILITATOR:**|**FACILITATOR:**|**FACILITATOR:**|**FACILITATOR:**|**FACILITATOR:**|**FACILITATOR:**|**FACILITATOR:**|**FACILITATOR:**|
|**GROUP NAME:**|**GROUP NAME:**|**GROUP NAME:**|**GROUP NAME:**|**GROUP NAME:**|**GROUP NAME:**|**GROUP NAME:**|**GROUP NAME:**|
|**Date Submitted:**
|**Date Submitted:**
|**Date Submitted:**
|**Date Submitted:**
|**Date Submitted:**
|**Date Submitted:**
|**Date Submitted:**
|**Date Submitted:**
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||**Identification**
**Number**
|**Participant Name**
**(Last, First)**|
**Start Date **|**Termination**
**Reason**|**Pre-Test**
**Score**|**Post-Test**
**Score**|**Termination**
**Date**|
||_1234567890_|_Smith, Johnny Ray_|_7-01-03_||||_01-28-04_|
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|**Instructions:**|**Instructions:**|**Instructions:**|**Instructions:**|**Instructions:**|**Instructions:**|**Instructions:**|**Instructions:**|
|**Group facilitators must complete this form upon starting a new group. The participant’s name must be the exact name as listed by the GDC.**
**The identification number must be the assigned GDC number for offenders (State Prisons and Transitional Centers). The start date must be**
**entered as the first official day of class. The termination date for each participant must be the last date they attended class. The termination code**
**should be an applicable code (refer to page two).**|**Group facilitators must complete this form upon starting a new group. The participant’s name must be the exact name as listed by the GDC.**
**The identification number must be the assigned GDC number for offenders (State Prisons and Transitional Centers). The start date must be**
**entered as the first official day of class. The termination date for each participant must be the last date they attended class. The termination code**
**should be an applicable code (refer to page two).**|**Group facilitators must complete this form upon starting a new group. The participant’s name must be the exact name as listed by the GDC.**
**The identification number must be the assigned GDC number for offenders (State Prisons and Transitional Centers). The start date must be**
**entered as the first official day of class. The termination date for each participant must be the last date they attended class. The termination code**
**should be an applicable code (refer to page two).**|**Group facilitators must complete this form upon starting a new group. The participant’s name must be the exact name as listed by the GDC.**
**The identification number must be the assigned GDC number for offenders (State Prisons and Transitional Centers). The start date must be**
**entered as the first official day of class. The termination date for each participant must be the last date they attended class. The termination code**
**should be an applicable code (refer to page two).**|**Group facilitators must complete this form upon starting a new group. The participant’s name must be the exact name as listed by the GDC.**
**The identification number must be the assigned GDC number for offenders (State Prisons and Transitional Centers). The start date must be**
**entered as the first official day of class. The termination date for each participant must be the last date they attended class. The termination code**
**should be an applicable code (refer to page two).**|**Group facilitators must complete this form upon starting a new group. The participant’s name must be the exact name as listed by the GDC.**
**The identification number must be the assigned GDC number for offenders (State Prisons and Transitional Centers). The start date must be**
**entered as the first official day of class. The termination date for each participant must be the last date they attended class. The termination code**
**should be an applicable code (refer to page two).**|**Group facilitators must complete this form upon starting a new group. The participant’s name must be the exact name as listed by the GDC.**
**The identification number must be the assigned GDC number for offenders (State Prisons and Transitional Centers). The start date must be**
**entered as the first official day of class. The termination date for each participant must be the last date they attended class. The termination code**
**should be an applicable code (refer to page two).**|**Group facilitators must complete this form upon starting a new group. The participant’s name must be the exact name as listed by the GDC.**
**The identification number must be the assigned GDC number for offenders (State Prisons and Transitional Centers). The start date must be**
**entered as the first official day of class. The termination date for each participant must be the last date they attended class. The termination code**
**should be an applicable code (refer to page two).**|
|**The Operations Analyst/Designee or other staff member who makes SCRIBE data entries must be given a copy of this form to enter information**
**into SCRIBE. Facilitators are to forward this form to the OA each time there is a change of offender class status. The OA will enter the data and**
**indicate date entered, initial, and return the form to the group facilitator within seven (7) days of receipt.**|**The Operations Analyst/Designee or other staff member who makes SCRIBE data entries must be given a copy of this form to enter information**
**into SCRIBE. Facilitators are to forward this form to the OA each time there is a change of offender class status. The OA will enter the data and**
**indicate date entered, initial, and return the form to the group facilitator within seven (7) days of receipt.**|**The Operations Analyst/Designee or other staff member who makes SCRIBE data entries must be given a copy of this form to enter information**
**into SCRIBE. Facilitators are to forward this form to the OA each time there is a change of offender class status. The OA will enter the data and**
**indicate date entered, initial, and return the form to the group facilitator within seven (7) days of receipt.**|**The Operations Analyst/Designee or other staff member who makes SCRIBE data entries must be given a copy of this form to enter information**
**into SCRIBE. Facilitators are to forward this form to the OA each time there is a change of offender class status. The OA will enter the data and**
**indicate date entered, initial, and return the form to the group facilitator within seven (7) days of receipt.**|**The Operations Analyst/Designee or other staff member who makes SCRIBE data entries must be given a copy of this form to enter information**
**into SCRIBE. Facilitators are to forward this form to the OA each time there is a change of offender class status. The OA will enter the data and**
**indicate date entered, initial, and return the form to the group facilitator within seven (7) days of receipt.**|**The Operations Analyst/Designee or other staff member who makes SCRIBE data entries must be given a copy of this form to enter information**
**into SCRIBE. Facilitators are to forward this form to the OA each time there is a change of offender class status. The OA will enter the data and**
**indicate date entered, initial, and return the form to the group facilitator within seven (7) days of receipt.**|**The Operations Analyst/Designee or other staff member who makes SCRIBE data entries must be given a copy of this form to enter information**
**into SCRIBE. Facilitators are to forward this form to the OA each time there is a change of offender class status. The OA will enter the data and**
**indicate date entered, initial, and return the form to the group facilitator within seven (7) days of receipt.**|**The Operations Analyst/Designee or other staff member who makes SCRIBE data entries must be given a copy of this form to enter information**
**into SCRIBE. Facilitators are to forward this form to the OA each time there is a change of offender class status. The OA will enter the data and**
**indicate date entered, initial, and return the form to the group facilitator within seven (7) days of receipt.**|
|**The SSPC will review this form during QA Evaluations and/or site visits.**|**The SSPC will review this form during QA Evaluations and/or site visits.**|**The SSPC will review this form during QA Evaluations and/or site visits.**|**The SSPC will review this form during QA Evaluations and/or site visits.**|**The SSPC will review this form during QA Evaluations and/or site visits.**|**The SSPC will review this form during QA Evaluations and/or site visits.**|**The SSPC will review this form during QA Evaluations and/or site visits.**|**The SSPC will review this form during QA Evaluations and/or site visits.**|
**Date Entered: _____________________________________ OA Initials: ______________________**
**Classification Chair Signature: ________________________________ Date Reviewed: __________________________**
Retention Schedule: Upon completion, this form shall be maintained on site for at least one (1) year or upon review by the Social
Services Program Consultant (SSPC).
SOP 107.05
Attachment 1
5/12/22
Page 2 of 2
# **Georgia Department of Corrections** **Office of Reentry Services** **PROGRAM DATA FORM**
**END REASONS**
Retention Schedule: Upon completion, this form shall be maintained on site for at least one (1) year or upon review by the Social
Services Program Consultant (SSPC).