SUPERIOR COURT OF CALIFORNIA, COUNTY OF INYO Street Address: 168 North Edwards Street Mailing Address: Post Office Drawer U Independence, CA 93526 Branch Name: PEOPLE OF THE STATE OF CALIFORNIA VS. DEFENDANT: CASE NUMBER: ANGER MANAGEMENT PROGRAM COMPLETION/TERMINATION NOTICE Name and address of program: Report date: Intake date: Class start date: Completion date: Termination date: THIS COMPLETED FORM MUST BE PROVIDED TO THE PROBATION DEPARTMENT OR THE COURT __________COMPLETION NOTICE __________TERMINATION NOTICE A. ASSESSMENT: 1. ATTENDANCE Satisfactory Unsatisfactory 2. Classes attended: ____________________ Excused absences: ___________________ PAYMENT OF FEES Satisfactory 3. Unexcused absences: ____________ Unsatisfactory Amount owing: _________________________________ PARTICIPATION Satisfactory Unsatisfactory (explain) 4. EVALUATION and RECOMMENTATION This evaluation takes into consideration the individual’s level of compliance with the program requirements as well as an appropriate demonstration of the individual’s acquired level of knowledge, understanding a awareness of (a) what violent/abusive behavior is and (b) the individual’s behavior potential as related to maintaining a nonviolent/nonabusive lifestyle. This evaluation of abilities takes into consideration the following: ITEMS EVALUATED (1 = unacceptable 2 = poor 3 = fair 4 = good 5 = excellent) Cooperation and participation in the program __________ Sufficient knowledge and understanding to be consistently violence free __________ Sufficient knowledge and understanding to practice healthy conflict-resolution skills __________ Sufficient knowledge and understanding to practice restraint in areas of blame shifting, degradation, committing acts that dehumanize or jeopardize another individual in any way __________ Sufficient knowledge and understanding to ascertain that he use of coercion or violent/abusive behavior to maintain dominance is unacceptable in an intimate relationship __________ Sufficient knowledge and understanding to avoid making threats of harm to others __________ To the best of our knowledge has complied with requirements to receive alcohol/drug counseling, or other mandates by the judicial system and this program. __________ Page 1 of 2 ANGER MANAGEMENT COMPLETION/TERMINATION NOTICE IC-CR-AM 102 (04-30-08) American LegalNet, Inc. www.FormsWorkflow.com PEOPLE OF THE STATE OF CALIFORNIA vs. CASE NUMBER: DEFENDANT/RESPONDENT: 5. PROGRESS EVALUATION AND RECOMMENDATIONS a. Individual is is not in compliance with program requirements. COMMENTS: _________________________________________________________________________________ _____________________________________________________________________________________________ ______________________________________________________________________________________________ _________________________________________________________________________________________________________ B. NOTICE OF TERMINATION Attendee was terminated from the program for the following reasons (check all that apply) Violated one or more terms of the “no-contact” order issued by the court. The program was notified of a report of abuse or threat of abuse by attendee. The program was notified of attendee’s use of threats, intimidation, or violence. Attendee was violent and/or abusive in group. Failed to demonstrate meaningful group participation. Failed to pay program fees or provide required fee documentation. Failed to adhere to attendance policies. Failed to comply with program contract or other rules and policies. Other: ________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ Provider shall retain a copy of this form. Submitted on (date): _________________________________________________ (Print Program Provider Name) _________________________________________________ (Program Provider Signature) Page 2 of 2 ANGER MANAGEMENT PROGRAM COMPLETION/TERMINATION NOTICE IC-CR-AM 102 (04-30-08) American LegalNet, Inc. www.FormsWorkflow.com