SOP_NUMBER: 220.03-att-13
TITLE: Offender Refusal Form
REFERENCE_CODE: IIC02-0004
DIVISION: Unknown
TOPIC_AREA: 107 Policy-Counseling/Risk Reduction
EFFECTIVE_DATE: 2022-07-26
WORD_COUNT: 129
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/184604
URL: https://gps.press/sop-data/220.03-att-13/

SUMMARY:
This form documents when an offender refuses to participate in a required program that has been identified as necessary for their treatment and rehabilitation. The form captures the offender's reasons for refusal and ensures the offender understands that program non-completion may negatively impact parole consideration and could result in delayed or denied parole. The form must be signed by the offender and witnessed by a counselor, then placed in the offender's institutional file.

KEY_TOPICS: offender refusal, program refusal, counseling refusal, parole impact, program non-completion, risk reduction programs, offender documentation, institutional file, NGA needs assessment, parole consideration

ATTACHMENTS:
  1. Classification Committee Form
     URL: https://gps.press/sop-data/220.03-att-1/
  2. Classification Detail Request Form
     URL: https://gps.press/sop-data/220.03-att-2/
  3. Classification Appeal Form (Attachment 3)
     URL: https://gps.press/sop-data/220.03-att-3/
  4. Special Parole Review Recommendation Form
     URL: https://gps.press/sop-data/220.03-att-4/
  5. Classification Action Sheet - Reclassification Form (Inside Only)
     URL: https://gps.press/sop-data/220.03-att-5/
  6. Transitional Services Criteria (Work-Release) and Long Term Maintenance Criteria
     URL: https://gps.press/sop-data/220.03-att-6/
  7. Notification of Registered Sex Offenders Transfer
     URL: https://gps.press/sop-data/220.03-att-7/
  8. Counselor Request Form (Attachment 8)
     URL: https://gps.press/sop-data/220.03-att-8/
  9. Movement Plan Memo Template
     URL: https://gps.press/sop-data/220.03-att-9/
  10. Facility Stratification Plan Template
     URL: https://gps.press/sop-data/220.03-att-10/
  11. 48-Hour Waiver (Reclassification)
     URL: https://gps.press/sop-data/220.03-att-11/
  12. County Facility Placement Criteria
     URL: https://gps.press/sop-data/220.03-att-12/
  13. Offender Refusal Form
     URL: https://gps.press/sop-data/220.03-att-13/
  14. Operational Manual Template
     URL: https://gps.press/sop-data/220.03-att-14/
  15. Reclassification Move Request Form
     URL: https://gps.press/sop-data/220.03-att-15/
  16. Classification/Reclassification Summary Report
     URL: https://gps.press/sop-data/220.03-att-16/
  17. 48-Hour Classification Notification Form
     URL: https://gps.press/sop-data/220.03-att-17/

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FULL TEXT:
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SOP 220.03
Attachment 13

07/26/22

**Georgia Department of Corrections**

**Offender Refusal Form**

Offender: _________________________________GDC Number___________________

Date: __________________

Program Name___________________________________________________________

The above offender REFUSED to attend the above listed program due to the following reasons:

_______________ Offender has refused programs stating he has to max out.
_______________ Offender has been denied Parole.
_______________ Other  _______________________________________________

Offender Statement:

The NGA indicates that I have to complete the above listed program that was identified
as a need for program treatment.

I understand that failure to complete the program could reflect negatively upon my parole
consideration and my parole could be delayed or denied entirely.

_____________________________________________________
Offender Signature and State Identification Number

The above statement has been read and explained to the inmate.

Witnessed: ________________________________________ _______________
Counselor Date


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