SOP_NUMBER: 214.04-att-1 TITLE: Participation Agreement WORD_COUNT: 665 POWERDMS_URL: https://public.powerdms.com/GADOC/documents/1214525 URL: https://gps.press/sop-data/214.04-att-1/ ATTACHMENTS: 1. Participation Agreement URL: https://gps.press/sop-data/214.04-att-1/ 2. TCU CTSFORM – Criminal Thinking Scales: Scales and Item Scoring Guide URL: https://gps.press/sop-data/214.04-att-2/ 3. TCU CTS Form (Attachment 3) - Thinking Style and Criminal Thinking Patterns Assessment URL: https://gps.press/sop-data/214.04-att-3/ 4. EBP Elective Proposal URL: https://gps.press/sop-data/214.04-att-4/ 5. Evidence Based Program Weekly Report URL: https://gps.press/sop-data/214.04-att-5/ ======================================================================== FULL TEXT: ======================================================================== SOP 214.04 Attachment 1 02/20/25 Page 1 of 2 **Evidence Based Prison** **OFFENDER PARTICIPATION AGREEMENT** **I, ________________________________understand that there are a number of rules and** **expectations which I must respect as a participant in the Evidence Based Program. By** **signing this agreement, I acknowledge my awareness and understanding of the following:** **1.** **I understand that I was referred to this program. I also understand that I am** **showing a willingness to participate in this program to make changes in my life.** **2.** **I understand that this is a 2-year program, and I am committing to actively** **participate during this time.** **3.** **I agree to promptly attend all scheduled sessions unless given an excused absence** **from staff.** **I also understand that the program staff and/or volunteers have the discretion to** **determine if my missing a session was legitimate. I understand that if my progress** **in the program is affected by excessive absences I may be terminated from the** **program and not receive a certificate of program completion.** **4.** **I understand that the personal information discussed in the groups is confidential** **and I agree to respect this confidentiality by not discussing the information outside** **the group. However, I also understand that if I say anything that could show I plan** **to harm myself, someone else or the safety of the prison, my counselor, facilitator, or** **other staff will report the information.** **5.** **I understand that I will be discharged from the program if I violate any of the** **following:** - **Acts of physical violence, possession of weapons, gang-related activity,** - **Escape planning, use and/or possession of alcohol or any illicit drugs,** **and any act, which puts at risk the program, program participants,** **staff, volunteers, or the institution.** - **Possession of a cell phone** **6.** **I understand the program will support and follow all institutional rules and** **regulations outlined in the inmate handbook. I agree to follow all institutional and** **program rules and procedures.** **7.** **I understand that during the time I am an active participant in this program I will** **be housed at the Evidence Based Prison.** **8.** **At all times I will conduct myself with respect for each participant, staff, and** **volunteer.** Retention Schedule: Upon completion this form shall be maintained in offender’s file for two (2) years or if program completion occurs prior to two (2) years, it may be removed. SOP 214.04 Attachment 1 02/20/25 Page 1 of 2 **9.** **I am to always keep myself and the dormitory inspection ready.** **10.** **I understand I may be discharged for lack of progress toward goals and/or** **consistent violation of rules and procedures.** **11.** **I understand that I will receive a Certificate of Completion if I satisfactorily meet all** **requirements of the program.** **THE ABOVE INFORMATION HAS BEEN EXPLAINED TO ME AND I HAVE** **RECEIVED A COPY OF THE PROGRAM RULES.** |Printed Name of
Offender|Col2|GDC
Number|Col4| |---|---|---|---| |**Participant**
**Shirts Issued**|**Date: ____________________**
**Quantity: ________________**
**(should be 3)**|**Participant**
**Shirts**
**Returned**|**Date: ____________**
**Quantity: ________**
**(should be 3)**| |**Signature of**
**Offender**||
**Date**|| |**Offender Agrees to participate**** Offender Refused to participate**|**Offender Agrees to participate**** Offender Refused to participate**|**Offender Agrees to participate**** Offender Refused to participate**|**Offender Agrees to participate**** Offender Refused to participate**| |**Printed Name of**
**GDC Staff**||
**Facility**|| |**Signature of**
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**Date**|| |**Status**|**Approved**
**Denied**|**Anticipated**
**Start Date**|| |**GDC ONLY COMPLETION FOR PROGRAM DISMISSAL**|**GDC ONLY COMPLETION FOR PROGRAM DISMISSAL**|**GDC ONLY COMPLETION FOR PROGRAM DISMISSAL**|**GDC ONLY COMPLETION FOR PROGRAM DISMISSAL**| |**Offender Dismissal from program effective date:**|**Offender Dismissal from program effective date:**|**Offender Dismissal from program effective date:**|**Offender Dismissal from program effective date:**| |**Justification for program dismissal**
|**Justification for program dismissal**
|**Justification for program dismissal**
|**Justification for program dismissal**
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| |**Offender is eligible to participate date:**|**Offender is eligible to participate date:**|**Offender is eligible to participate date:**|**Offender is eligible to participate date:**| |**GDC Staff (printed name & title):**|**GDC Staff (printed name & title):**|**GDC Staff (printed name & title):**|**GDC Staff (printed name & title):**| ||||| Retention Schedule: Upon completion this form shall be maintained in offender’s file for two (2) years or if program completion occurs prior to two (2) years, it may be removed.