SOP 214.04-att-5: Evidence Based Program Weekly Report
Summary
Key Topics
- Evidence Based Program
- EBP
- weekly reporting
- program phases
- mentors
- Pathfinders
- Identity Reformation
- graduation rates
- electives
- family day
- disciplinary referrals
- offender programs
- facilities programs
- program tracking
Full Text
SOP 214.04
Attachment 5
02/20/25
Page 1 of 4
Evidence Based Program Weekly Report Facility Name Submitted By
|Facility Name|Col2|Week-of|Col4|
|---|---|---|---|
|Submitted by||Date||
|_This is one week retroactive of report due date_
_(Example: report due Wednesday May 31st is for activities from Wednesday May 24-May_
_Tuesday May 30th) _|_This is one week retroactive of report due date_
_(Example: report due Wednesday May 31st is for activities from Wednesday May 24-May_
_Tuesday May 30th) _|_This is one week retroactive of report due date_
_(Example: report due Wednesday May 31st is for activities from Wednesday May 24-May_
_Tuesday May 30th) _|_This is one week retroactive of report due date_
_(Example: report due Wednesday May 31st is for activities from Wednesday May 24-May_
_Tuesday May 30th) _|
# Weekly Activities
Retention Schedule: Upon completion this form shall be maintained by the Statewide EBP Coordinator for two (2)
years.
SOP 214.04
Attachment 5
02/20/25
Page 2 of 4
# Proposal
|Ideas presented that further the goals and mission of EPB that establish a positive forward
momentum. This is required on a minimum monthly basis|Col2|
|---|---|
|Proposal
Name/Idea||
|Result| Approved by _______________ Denied BY_________________
|
|Mentors|Col2|Col3|Col4|Col5|
|---|---|---|---|---|
||Completed|Enrolled|Start Date|End Date|
|Total Number of
Mentors:|||||
|Pathfinders:|||||
|Identity
Reformation|||||
|Mentor Meeting
Date and take ways
from meeting|||||
# Phase Numbers:
|Pre-Phase|Col2|Phase 1|Col4|
|---|---|---|---|
|Phase 2|
|Phase 3||
|Phase 4|
|Graduates Phase||
|Mentors|
|Fire Station||
|Total Offenders||||
Start and end Date of any EBP Training: __________________________________________
Graduation Date: ______________________________________________________________
# Graduation Rates
|Year|Col2|
|---|---|
|2023||
|2024||
|Total||
Retention Schedule: Upon completion this form shall be maintained by the Statewide EBP Coordinator for two (2)
years.
SOP 214.04
Attachment 5
02/20/25
Page 3 of 4
# Electives
_(use additional sheets as needed)_
|Col1|Elective|Number of Offenders|
|---|---|---|
|1 |||
|2 |||
|3 |||
|4 |||
|5 |||
|6 |||
|7 |||
|8 |||
|9 |||
|10|||
|11|||
|12|||
|13|||
|14|||
|15|||
|16|||
|17|||
|18|||
|19|||
|20|||
|21|||
|22|||
|23|||
|24|||
|25|||
|26|||
|27|||
|28|||
|29|||
|30|||
|31|||
|32|||
|33|||
|34|||
||_Total_||
# Family Day
Retention Schedule: Upon completion this form shall be maintained by the Statewide EBP Coordinator for two (2)
years.
SOP 214.04
Attachment 5
02/20/25
Page 4 of 4
|Date:|Col2|
|---|---|
|Family Day Goals/Accomplishments:||
|Family Day Goals/Accomplishments:||
|Family Day Goals/Accomplishments:||
# Disciplinary Referrals
Retention Schedule: Upon completion this form shall be maintained by the Statewide EBP Coordinator for two (2)
years.