DV-815 1 2 Batterer Intervention Program Progress Report Clerk stamps date here when form is filed. Name of Protected Person: Name of Restrained Person: Lawyer for Restrained Person (if you have one for this case): State Bar No.: Name: Address (Address of lawyer or address of restrained person. Do not provide an address that should be kept private.): City: Telephone: E-mail Address: State: Fax: Zip: Fill in court name and street address: Superior Court of California, County of Items 3 through 5 must be completed by the program 3 Batterer Intervention Program a. Name of Program: Court fills in case number when form is filed. Address: Case Number: City: State: Zip: Telephone: Report date: Intake date: Class start date: b. This 52-week program is approved by the probation department under Penal Code section 1203.097. TO PROGRAM STAFF: If you choose to provide another report that contains all the information in 4 , skip to 5 and attach your report. Do not forget to provide your name, title, signature, and date at the end of this form. 4 Program Attendance and Progress a. Number of sessions completed: Number of sessions missed: Of the sessions missed, how many excused? b. The person in 2 is participating and expected to finish by (date): c. The person in 2 successfully completed the program on (date): d. The person in 2 was terminated from the program on (date): , for the following reason (explain): 5 Optional Report The attached report includes all information required under California Family code section 6343. NOTICE TO PROGRAM PROVIDER This form should NOT be used to disclose information (example: medical or health information) that is protected under state and federal laws without appropriate written authorization from the person in 2 . I declare under penalty of perjury under the laws of the State of California that the information above is true and correct to the best of my knowledge. Date: (TYPE OR PRINT NAME AND TITLE) Judicial Council of California, www.courts.ca.gov New July 1, 2016, Optional Form Family Code, § 6343 (Signature of program staff) DV-815, Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com Batterer Intervention Program Progress Report