Community Accountability Programs Information ... - Ministry of Justice
Community Accountability Programs Information ... - Ministry of Justice
Community Accountability Programs Information ... - Ministry of Justice
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QUARTERLY DATA COLLECTION FORMName <strong>of</strong> program: _____________________________________________________________Mailing address: ______________________________________________________________Telephone numbers: ( )_________________ Fax Number ( ) ____________________Email: ______________________________________________________________________Contact name:________________________________________________________________Quarter: January-March April-June July-September October-DecemberYear: __________STATUS OF PROGRAM:Under development but hasn’t been implemented yetProgram plan complete Yes NoOperational(start date)_____________Other (specify)_______________________TYPE OF PROGRAM:CLIENTELE:Family Group Conferencing Youth Adults BothVictim Offender Reconciliation ProgramAGE RANGES:Neighborhood <strong>Accountability</strong> PanelCircle RemedyOther (specify) ____________________________Undetermined at this timeIF PROGRAM IS OPERATIONAL:List all referring agents:PoliceCrown counselJudiciarySchoolProbation OfficerCorrections contractorParentsOther (please specify) _____________Number <strong>of</strong> volunteers _______Number <strong>of</strong> volunteers trained _______Type <strong>of</strong> training provided (please describe)__________________________________________________________________________________________________________________________________________________________________________________________________Number <strong>of</strong> volunteers with criminal record checks_______Insurance coverageYes (please specify type) _________________________________NoPage 1 <strong>of</strong> 5