SOP 503.01-att-1: Faith and Character-Based Dormitory - Offender Application

Division:
Unknown
Effective Date:
August 7, 2025
Reference Code:
VK01-0001
Topic Area:
503.01 Policy - Facilities
PowerDMS:
View on PowerDMS
Length:
127 words

Summary

This is an application form for inmates who wish to participate in the Faith and Character-Based Dormitory (FCBD) program. The form collects demographic information, housing history, disciplinary record, educational background, program participation history, and the applicant's motivation for joining the program. Eligible inmates submit this application to be considered for placement in this specialized housing unit.

Key Topics

  • faith-based housing
  • character-based dormitory
  • FCBD
  • inmate application
  • housing placement
  • program participation
  • religious affiliation
  • disciplinary record
  • inmate programs
  • residential unit assignment

Full Text

503.01
Attachment 1

08/07/25
Faith and Character-Based Dormitory

Offender Application

LAST NAME : ____________________________ FIRST :________________

GDC NUMBER : _____________________ DOB : ______________

CURRENT HOUSING UNIT : ____________ CURRENT DETAIL : __________

LAST DISCIPLINARY REPORT : ____/____/____

PRIMARY LANGUAGE: __________ HEARING/VISUALLY IMPAIRED: YES NO

|RACE: (CIRCLE ONE)|Col2|Col3|Col4|
|---|---|---|---|
|ASIAN|AFRICAN AMERICAN|NATIVE AMERICAN|MULTIRACIAL|
|PACIFIC ISLANDER|HISPANIC/LATINO|WHITE|OTHER|

US CITIZEN : (CIRCLE ONE) YES / NO ICE/INS DETAINER : YES / NO

RELIGIOUS AFFILIATION: _____________________________

HIGHEST EDUCATIONAL LEVEL COMPLETED : ____________________________

TPM : ____/____/____ MRD : ____/____/____

DO YOU HAVE ANY MEDICAL PROFILES? YES NO IF SO, WHAT?
_______________________________________________________________________

PROGRAMS COMPLETED: (CIRCLE PROGRAMS TAKEN)

MOTIVATION FOR CHANGE PARENTING MRT PSSIA

MATRIX THINKING FOR A CHANGE CONFRONTING SELF SOPP

REENTRY SKILL BUILDING GED BEHAVIOR STABILIZATION

ABE FAMILY VIOLENCE ITC FCBD

VOCATIONAL___________

OJT__________________

WHY DO YOU WANT TO PARTICIPATE IN THE PROGRAM?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

DO NOT WRITE BELOW THIS LINE

Attachments (5)

  1. Faith and Character-Based Dormitory - Offender Application (127 words)
  2. Faith and Character Dormitory Offender Contract (373 words)
  3. Faith and Character-Based Dormitory Rules (331 words)
  4. Faith and Character-Based Program - Correctional Associate (Volunteer) Contract (143 words)
  5. Faith and Character-Based Prison Application (101 words)
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