SOP 215.07-att-1: Resident Pass Application and Authorization

SOP 215.07
Attachment 1
5/27/20

GEORGIA DEPARTMENT OF CORRECTIONS
TRANSITIONAL CENTER RESIDENT PASS APPLICATION/AUTHORIZATION

Dorm/Bed:__________________________________ Counselor:_________________________

Name: ________________________________ Cell Phone #: ___________________________ GDC#: _______________

Date of Pass: ____________ Total Hours: _______ Departure: ________ Return: _____________

Destination: ________________________________________________________________________________________

___________________________________________________________________________________________________
Name Relationship Address Phone No. Arr. Time Dep. Time

** Call Center upon arrival and departure **
Person(s) who will provide transportation to and from the Center:

________________________________________________________________________________________
Name Relationship Address Phone No.

If granted this pass, I pledge that I will at all times conduct myself in a responsible manner that will not bring adverse community reactions to
myself, the Department of Corrections, or to the community facility program. Furthermore, I have read or have had read to me the conditions
governing this pass and understand them fully. Should I fail to return at the prescribed time, I understand that the established escape fee will
be taken from my account, and that severe disciplinary consequences may result. I also understand that I may be charged with the criminal
offense of escape and I hereby waive all rights of extradition. I agree to submit to search of my body and possessions upon return from pass, I
am prohibited from consuming alcohol/drugs while on pass and I will submit to alcohol/drug testing if so instructed upon my return.

Date: _______________ Resident's Signature: _______________________________

The resident meets eligibility requirements for the following pass:

W-R 30-day (6hr) W-R 60 Day (9hr) ____ W-R 90 Day (12hr)

Approved / Disapproved ___________________________Approved / Disapproved___________________________
Counselor Security

Approved / Disapproved ___________________________Approved / Disapproved___________________________
Employment Specialist Assistant Superintendent

Approved / Disapproved_____________________________________Date_________________________________
Superintendent
Comments: ____________________________________________________________________________________

Under provisions of Georgia Law, the Department of Corrections has granted this leave for the purpose or period outlined above. Any
deviation from this or violation of local or State laws should immediately be reported to the Superintendent or the Center.

RETURN Prescribed Time: ____________________ RETURN Actual Time: _____________________________

Violations: ( ) Yes ( ) No _ Contraband Search _ Alcohol Test _ Drug Screen _ Other

Comments: _______________________________________________________________________________________________________

Correctional Officer: _______________________________________________ Date: __________________

Retention Schedule: Upon completion, this form shall be placed in the resident’s institutional file and maintained according to the official
retention schedule for that file.