SOP_NUMBER: 209.11-att-7
TITLE: RHA-JOAS Program 30 Day Review_Assignment Appeal Form
WORD_COUNT: 183
URL: https://gps.press/sop-data/209.11-att-7/

ATTACHMENTS:
  1. RHA-JOAS Program Assignment Recommendation and 1, RHA-JOAS Program Initial Segregation Review
     URL: https://gps.press/sop-data/209.11-att-1/
  2. Restrictive Housing Assignment – Juvenile Offender Administrative Segregation Assignment Memo
     URL: https://gps.press/sop-data/209.11-att-2/
  3. Restrictive Housing Assignment – Juvenile Offender Administrative Segregation Assignment Appeal Form
     URL: https://gps.press/sop-data/209.11-att-3/
  4. Restrictive Housing Assignment - Juvenile Offender Administrative Segregation Program Handout
     URL: https://gps.press/sop-data/209.11-att-4/
  5. Restrictive Housing Assignment - Juvenile Offender Administrative Segregation 30 Day Review
     URL: https://gps.press/sop-data/209.11-att-5/
  6. Restrictive Housing Assignment - Juvenile Offender Administrative Segregation 30 Day Review Memo
     URL: https://gps.press/sop-data/209.11-att-6/
  7. RHA-JOAS Program 30 Day Review_Assignment Appeal Form
     URL: https://gps.press/sop-data/209.11-att-7/
  8. Restrictive Housing Assignment – Juvenile Offender Administrative Segregation Cell Check Sheet
     URL: https://gps.press/sop-data/209.11-att-8/
  9. Restrictive Housing Assignment - Juvenile Offender Administrative Segregation: Checklist (RHA-JOAS Checklist)
     URL: https://gps.press/sop-data/209.11-att-9/
  10. RHA-JOAS Checklist - 30-Minute and 15-Minute Watch Form_Observation Record
     URL: https://gps.press/sop-data/209.11-att-10/
  11. Restrictive Housing Assignment - Juvenile Offender Administrative Segregation Performance Recording Sheet
     URL: https://gps.press/sop-data/209.11-att-11/

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FULL TEXT:
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**Attachment 7**

**SOP 209.11**

**(04/11/16)**

**Restrictive Housing Assignment - Juvenile Offender Administrative Segregation**

**30 Day Review Appeal Form**

**I. Juvenile Offender: __________________________GDC#:__________________ DATE: ____________**

**II.  Restrictive Housing Assignment - Juvenile Offender Administrative Segregation Assignment:**


**In accordance with Restrictive Housing Assignment - Juvenile Offender Administrative Segregation SOP, a 30 Day**
**Review was conducted with the following recommendation:**
**_______________________________________________________________________________**

**_______________________________________________________________________________**

**III.  Offender's rebuttal: (within 3 business days submit to the assigned counselor who will forward to the Warden)**

**_______________________________________________________________________________**

**_______________________________________________________________________________**

**_______________________________________________________________________________**

**_______________________________________________________________________________**

**DATE APPEAL RECEIVED: ________________________ BY:_________________________________________(COUNSELOR)**

**IV.  Review of Appeal:**

**_____I** **concur /** **disagree with the Restrictive Housing Assignment - Juvenile Offender Administrative**
**Segregation Program Classification Committee’s Action. The following decision(s) has/have been made in this case:**

**___________________________________________________________________________________**

**_________________________________________________________________________________**

**___________________________** **_______________________**
**Warden’s Signature** **Date**

**Copies:** **Offender**
**RETENTION SCHEDULE:  Upon completion of this form, it shall be placed in the juvenile offender’s case history file.**
**-------------------------------------------------------------------------------------------------------------------------------------**

**OFFENDER RECEIPT FOR** **RESTRICTIVE HOUSING ASSIGNMENT - JUVENILE OFFENDER ADMINISTRATIVE**
**SEGREGATION PROGRAM ASSIGNMENT**


**JUVENILE OFFENDER’S NAME: ______________________________________ I.D. #: ______________________**

**I ACKNOWLEDGE RECEIPT OF THIS APPEAL FROM THE ABOVE OFFENDER.**

**DATE: ___/___/____** **COUNSELOR’S SIGNATURE: ____________________________**


RETENTION SCHEDULE: Upon completion of this form, it shall be placed in the juvenile offender’s case history file.