SOP 209.11-att-3: Restrictive Housing Assignment – Juvenile Offender Administrative Segregation Assignment Appeal Form
Summary
Key Topics
- juvenile offender appeal
- restrictive housing appeal
- administrative segregation appeal
- RHA-JOAS
- solitary confinement
- segregation assignment
- appeal form
- appeal process
- rebuttal
- juvenile discipline
Full Text
Attachment 3
SOP 209.11
(04/11/16)
Restrictive Housing Assignment – Juvenile Offender Administrative Segregation
Assignment Appeal Form
I. Juvenile offender:__________________________ GDC #:________________DATE:____________
II. Restrictive Housing Assignment – Juvenile Offender Administrative Segregation
Assignment
In accordance with GDC SOP, you were placed in the Restrictive Housing Assignment – Juvenile Offender
Administrative Segregation for the following reasons:
_______________________________________________________________________________
_______________________________________________________________________________
III. Juvenile offender's rebuttal: (within 3 business days submit to the assigned counselor who will forward to the
Director of Field Operations Office).
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
DATE APPEAL RECEIVED: ___________________________ BY:_______________________________________(COUNSELOR)
IV. Review of Appeal
_____I concur / disagree with the Restrictive Housing Assignment – Juvenile Offender Administrative
Segregation Classification Committee / Warden’s Action. The following decision(s) has/have been made in this case.
___________________________________________________________________________________
_________________________________________________________________________________
__________________________________________ _______________________
Director of Field Operations / Designee’s Signature
Date
Copies: Offender
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JUVENILE OFFENDER RECEIPT FOR RESTRICTIVE HOUSING ASSIGNMENT – JUVENILE OFFENDER
ADMINISTRATIVE SEGREGATION ASSIGNMENT
Juvenile Offender’s Name: ______________________________________ I.D. #: ______________________
I acknowledge receipt of this appeal from the above juvenile offender.
Date: ___/___/____ Counselor’s Signature: ____________________________
RETENTION SCHEDULE: Upon completion of this form, it shall be placed in the juvenile offender’s case history file.