SOP 220.07-att-1: Parole Review Summary Form (IIC02-0001)
Summary
Key Topics
- parole review
- parole consideration
- max out
- life sentence
- disciplinary reports
- institutional behavior
- parole board recommendation
- release plan
- case management
- mental health program
- TABE scores
- tentative parole month (TPM)
- parole consideration date (PCD)
Full Text
Attachment 1
IIC02-0001
(220.07)
(07/16/15)
PAROLE REVIEW SUMMARY
Facility/Center:_______________________________________________Date Submitted: ___/___/___
I. Inmate: Name:_______________________________________________Number:____|____|____|_____
II. Type case: Parole _____Max Out _____Life Sent. _____ Type Report: Initial: ______ Update:______
Review date:TPM_____PCD_____Mo_____Yr______ Rpt.period:From_____/_____To_____/_____
(TPM Tentative Parole Month PCD Parole Consideration Date)
III. Disciplinary Reports and Dispositions: This report period only:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
IV. Proposed Plan for Residence and Employment Upon Release:
________________________________________________________________________________________
________________________________________________________________________________________
V. Case Management Summary:
a. Current status Mental Health/Mental Retardation Program: Active( ) Non active( )
b. Comment upon institutional adjustment, staff/peer relationships, and overall performance. It is imperative
to include a statement regarding the response to treatment of any inmate currently active in the Mental
Health/Mental Retardation Program.
c. Highest TABE reading level attained |___|___|___| Date of Test:Mo____Yr____ Academic program
participation: L/R ( ) ABE ( ) GED ( ) SpecEd ( )
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
VI. Summary Rating: Overall Institutional Behavior Above Average ( ) Average ( ) Below average ( )
VII. Recommendations: (Please place an X in each appropriate space).
a. Release in advance of TPM_____________or Max out Date___________ No______ Yes______
b. All TPM Extension _________ days accumulated to date.
c. Reduction of Disciplinary TPM Extension No ( ) Yes, by _____ days
__________________________________________ ___________________________________________
Signature Date
VIII. Warden's/Superintendent's Statement:
________________________________________________________________________________________
________________________________________________________________________________________
Summary Rating: Overall Institutional Behavior: Above average ( ) Average ( ) Below average ( )
__________________________________________ ___________________________________________
Signature Date
IX. Final GDC Recommendation to Parole Board (Central Office Use Only) Please consider this inmate:
Above average ( ) Average ( ) Below average ( )
TPM Extention of _____days.
__________________________________________ ___________________________________________
Signature Date
Distribution: Copies l and 2 Offender Administration
Copy 3 - Inmate Facility Administrative File (DOC Form #50-953(Rev 2/87)
RETENTION SCHEDULE: Upon completion, a copy of this form is to be retained in the administration case file.