Retained Jurisdiction Placement Evaluation Form

IDAHO DEPARTMENT OF CORRECTION
Retained Jurisdiction Placement Evaluation Form
Offender’s Full Name, (Last, First, Middle Initial):
Offender’s IDOC #:
DOB (MM/DD/YYYY):
Current Age:
Reception Facility:
☐Parole Commission Retained Jurisdiction
☐Court Retained Jurisdiction
Complete this section for Court Retained Jurisdiction
District:Judge:Retained Jurisdiction Ends:
Crime:Length of Jurisdiction:Completion Ordered:
Judge’s Recommendations:
Full Term Release Date:
First Retained Jurisdiction?☐Yes ☐NoIf not, where and when?
First Incarceration?☐Yes </w:☐NoIf not, where and when?
Significant Prior Criminal History: (e.g. Escape, Arson, Violence, and Juvenile Corrections):
Significant Behavioral History: (e.g. Violence, Prior Incarceration, or County Jail Disciplinary):
Medical or Mental Health Concerns?
Staffing Comments:
Retained Jurisdiction Types
☐CAPP☐CAPP CRP☐Sex Offender <☐ Traditional☐Therapeutic☐Mental Health
Recommended Housing
☐CAPP-Boise☐NICI </w:☐SBWCC ☐ISCI </☐PWCC </w:☐CWC <☐Other:
Report Prepared by:Date:
RDU Manager:Date:
324.02.01.001
05/19/2014