SOP 209.45-att-5: Tier II Segregated Transition Education Program (Tier II STEP) 90 Day Review Appeal Form

Attachment 5

SOP 209.45

04/25/19
Page 1 of 2

Tier II Segregated Transition Education Program (Tier II STEP)

90 Day Review Appeal Form

I. Offender: _________________________ GDC #: __________________ Date: ________________

II. Appeal of Tier II STEP Classification Committee 90 Day Review

I wish to appeal the decision of the Tier II STEP Classification Committee 90 Day Review:

REASON FOR APPEAL (submit to the assigned counselor within five (5) Business Days from date 90
Day Review Hearing Form (Atch 4) received, who shall forward to Director, Field Operations).

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

______________________________ _________________
Offender’s Signature Date

Date appeal received: ______________ By: _____________________________(COUNSELOR)

Offender Acknowledgment Appeal Received by Counselor: _____________________________
_Signature/Date_
Date Appeal Sent to Director, Field Operations: __________________ _(send within 3 calendar days of_
_receipt of Appeal)_

III. DIRECTOR, FIELD OPERATIONS REVIEW

Date Appeal Received: ________________

I concur / disagree with the Tier II STEP Classification Committee 90-Day Review and the
following recommendation(s) has been made in this case:

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

__________________________________ __________________
Director, Field Operations Date

Date Appeal Sent to Assistant Commissioner for Facilities: ____________________
_(Send within 3 business days of receipt of Appeal)_

Retention Schedule: Upon completion, this form shall be placed in the offender’s institutional file.

Attachment 5

SOP 209.45

04/25/19
Page 2 of 2

IV. ASSISTANT COMMISSIONER OF FACILITIES

Date Appeal Received: ________________

I concur / disagree with the Tier II STEP Classification Committee’s Action and the following
recommendation(s) has been made in this case:

_______________________________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________________

_________________________________________ __________________
Assistant Commissioner for Facilities DATE

VI. Offender’s Acknowledgment of Final 90 Day Review Appeal Decision

_______________________________________________
_Signature/Date_

Retention Schedule: Upon completion, this form shall be placed in the offender’s institutional file.