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Application For Appointment As Evaluator Of Persons Who Are Guilty Of Domestic Assault Or Battery Form. This is a Idaho form and can be use in Supreme Court Statewide.
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Tags: Application For Appointment As Evaluator Of Persons Who Are Guilty Of Domestic Assault Or Battery, Idaho Statewide, Supreme Court
IDAHO SUPREME COURT
451 WEST STATE STREET
P.O. BOX 83720
BOISE, IDAHO 83720-0101
(208)334-2246
APPLICATION FOR APPOINTMENT AS AN EVALUATOR OF PERSONS
WHO ARE GUILTY OF DOMESTIC ASSAULT OR DOMESTIC BATTERY
UNDER I.C. § 18-918
(IDAHO CRIMINAL RULE 33.3)
Part I
General Information
1.
Qualifications for Appointment:
To be deemed eligible for appointment as an evaluator, the applicant must be
licensed by the state of Idaho or other state as a physician, psychologist, master
social worker, professional counselor, marriage and family therapist, registered
nurse, nurse practitioner, or physician’s assistant. In addition, the applicant must
have a minimum of one year’s experience following licensure in the assessment
or treatment of domestic violence related issues, and submit evidence of twenty
(20) hours of specialized education or training in domestic violence matters
within the previous two years.
2.
Supporting Documentation:
An applicant must submit the following to be deemed eligible for appointment as
an evaluator by the Supreme Court:
A.
B.
3.
The attached application, including Part V, an affidavit of
compliance executed by the applicant attesting that the applicant
has fulfilled the requirements for appointment; and
A copy of the applicant’s current professional license.
To remain on the Supreme Court’s Roster of Evaluators:
In order for an evaluator to remain on the Supreme Court’s roster of evaluators,
the evaluator must file proof that the evaluator has taken a minimum of sixteen
(16) hours of continuing education or training in domestic violence related topics
during each preceding two (2) year period, by completing courses approved by
the Supreme Court. Proof that the continuing education requirement has been
satisfied must be submitted to the Supreme Court by July 1 of each two (2) year
period in order to be qualified for the succeeding two-year period.
4.
Applications must be typewritten and mailed or delivered to the Idaho Supreme
Court, c/o Administrative Director of the Courts, 451 West State Street, P.O. Box
83720-0101, telephone (208)334-2246.
5.
Idaho Code § 18-918 and Idaho Criminal Rule (I.C.R.) 33.3 (as revised effective
July 1, 2008, are attached for reference.
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IDAHO SUPREME COURT
APPLICATION FOR APPOINTMENT AS AN EVALUATOR
OF PERSONS WHO ARE GUILTY OF DOMESTIC ASSAULT
OR DOMESTIC BATTERY UNDER I.C. § 18-918
(IDAHO CRIMINAL RULE 33.3)
Part II
APPLICATION FORM
(Must Be Typewritten)
NAME
Organization
Mailing Address
City
Suite
County
Telephone (
)
State
Extension
FAX (
ZIP
)
E-Mail Address
Counties where you are willing to conduct evaluations?
The information you furnish above will be used in all correspondence with you and on the roster of evaluators.
I herewith apply for appointment by the Supreme Court as a person eligible to conduct evaluations of persons guilty of
domestic assault or domestic battery under Idaho Code § 18-918 pursuant to Rule 33.3, Idaho Criminal Rules.
In support of this application, I state the following:
I am licensed as a
by the state of
.
(Attach a copy of current professional license.)
I have
[contact]
[semester] hours of specialized education or training in domestic violence and
have a minimum of one year’s experience after licensure in the assessment or treatment of domestic violence related
issues. (Complete Parts III and IV.)
Signature
Date
Please return the completed application with supporting documentation to:
Idaho Supreme Court
Administrative Director of the Courts
451 West State Street
P.O. Box 83720
Boise, Idaho 83720-0101
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PART III
Twenty (20) hours of specialized Education or Training in
Domestic Violence within the past two years.
Documentation of course attendance must accompany the application.
Name:
Name of Training or Course:
Specify whether semester or contact hours and give the number of hours:
Dates attended:
Name of sponsoring organization:
Detailed explanation of course content and how it relates to domestic violence:
Name of Training or Course:
Specify whether semester or contact hours and give the number of hours:
Dates attended:
Name of sponsoring organization:
Detailed explanation of course content and how it relates to domestic violence:
(Please use additional sheets as needed.)
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PART IV
Experience After Licensure in the Assessment or Treatment of Domestic Violence
Related Issues
In what year was your license first obtained? ______________
Year:
Name, Address and Phone Number of Organization or Facility Providing Treatment or
Assessment: _____________________________________________________________
________________________________________________________________________
________________________________________________________________________
Name of Supervisor or Contact Person at this Facility or Organization:
Average hours per month:
Detailed Description of Experience:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Year:
Name, Address and Phone Number of Organization or Facility Providing Treatment or
Assessment: _____________________________________________________________
________________________________________________________________________
________________________________________________________________________
Name of Supervisor or Contact Person at this Facility or Organization:
Average hours per month:
Detailed Description of Experience:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(Please use additional sheets as needed.)
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IDAHO SUPREME COURT
APPLICATION FOR APPOINTMENT AS AN EVALUATOR
OF PERSONS WHO ARE GUILTY OF DOMESTIC ASSAULT
OR DOMESTIC BATTERY UNDER I.C. § 18-918
(IDAHO CRIMINAL RULE 33.3)
Part V
AFFIDAVIT OF COMPLIANCE
State of
County of
)
) ss.
)
To the Idaho Supreme Court:
I,
and say that:
, being first duly sworn, depose
I have submitted this application for appointment as a person eligible to conduct
evaluations of persons guilty of domestic assault or battery under Idaho Code § 18-918 pursuant
to Rule 33.3, Idaho Criminal Rules. By signing this application, I certify that I have satisfied the
requirements therein for making this application.
I fully realize that the determination as to whether I am appointed by the Supreme Court
depends on the truth and completeness of my answers set forth in this application and the
statements attached. To my knowledge, the answers and information which I have supplied in
connection with the application are true and complete.
I have read and understand the contents of Idaho Code § 18-918(5)(a) and Rule 33.3 of
the Idaho Criminal Rules, as revised by the Idaho Supreme Court on July 1, 2007, and I
will conduct the evaluation of persons guilty of domestic assault or battery in conformance with
these provisions.
Date:
Applicant's Signature
Subscribed and sworn to before me this
(SEAL)
day of
, 200
Notary Public for __________________
Residing at
My Commission Expires
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.
RULE 33.3. Evaluation of persons guilty of domestic
assault or domestic battery.
(a) Evaluators. Evaluators of persons who plead guilty or
are found guilty of domestic assault or domestic battery
under Idaho Code Section 18Ͳ918 shall be approved and shall
serve under the following provisions:
(1) Qualifications. An evaluator under Idaho Code
Section 18Ͳ918(7)(a) shall have the following qualifications:
(A) Licensed physician, licensed psychologist,
licensed master social worker, licensed social worker if approved
prior to July 1, 2008, licensed professional counselor, licensed
marriage and family therapist, licensed registered nurse, licensed
nurse practitioner or physician's assistant under the laws of the state
of Idaho; an evaluator may be licensed in the state of Idaho or any other state;
(B) Twenty (20) hours of specialized education or training in
domestic violence within the previous two years that meets the criteria
set out in subsection (2), as evidenced by an attached certificate of
completion or other supporting documentation;
(C) One year experience after licensure in
assessment or treatment of domestic violence related issues; and
(D) Approved by the Domestic Assault and Advisory
Board and maintained on a roster by the Administrative Director of
the Courts as persons eligible to conduct evaluations of persons
guilty of assault or domestic battery. In the event there is no
evaluator approved within the judicial district, then the requireͲ
ments of (B), (C), and (D) may be waived by the court.
(2) Continuing Education of Evaluators. Beginning the next
July 1 after an evaluator has been approved by the Domestic Assault
and Advisory Board, the evaluator must take at least sixteen (16)
hours of specialized training in domestic violence, or related topics
in courses approved by the Domestic Assault and Advisory
Board, in each and every two (2) year period following the July 1 date.
An evaluator must file proof of compliance with this requirement with
the Administrative Director of the Courts by July first of the year
the continuing education is due. Along with proof of compliance, an
evaluator must also send proof of current licensing.
(A) The sixteen (16) hours of training required in this
section shall be in one or more of the following
areas: (a) domestic violence; (b) violence in families;
(c) child abuse; (d) anger management; (e) risk factors
for future dangerousness; (f)psychiatric
causes of violence; or (g) drug and alcohol abuse.
However, no more than four (4) of the sixteen (16)
required hours may be in the area of drug and alcohol
abuse.
(B) The sixteen (16) hours of required training in this
section shall be acquired by completing a program approved or
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sponsored by one of the following associations: (a)
Idaho Psychiatric Association; (b) Idaho Psychologists
Association; (c) Idaho Nursing Association; (d)
Idaho Association of Social Workers; (e) Idaho Counselors
Association; (f) council on Domestic Violence and Victim
Assistance; (g) Idaho Coalition Against Sexual Assault and
Domestic Violence; or the national equivalent of any of these
organizations.
(C) Any program that does not meet the criteria set out in
both section (a)(2)(A) and section (a)(2)(B) may be
submitted to the board for approval either prior to or
after completion.
(3) Appointment Approval. All evaluators under Idaho
Code Section 18Ͳ918(8)(a) must be appointed approved by order of
the Domestic Assault and Advisory Board. Any person desiring to
be approved as an evaluator shall file an application for approval
with the Administrative Director of the Courts indicating the
qualifications of the applicant and the dates and content of relevant
training courses attended. An evaluator approved by
order of the Domestic Assault and Advisory Board may continue in
service from one calendar year to the next unless otherwise ordered
by the Domestic Assault and Advisory Board. The Administrative
Director of the Courts shall maintain a statewide list of approved
evaluators by the Domestic Assault and Advisory Board.
(b) Advisory Board. (1) Members. There is hereby created a
Domestic Assault and Battery Evaluator Advisory Board consisting
of six (6) members with experience and training in domestic
violence, as follows:
(A) A district judge or magistrate judge appointed
by the Supreme Court for a term of two years, who shall serve as
chair,
(B) The Administrative Director of the Courts, or his
or her designee,
(C) A social worker appointed by the Supreme
Court for a term of two years, upon submission of three (3) names
by the State Board of Social Work Examiners or appropriate
association,
(D) A counselor appointed by the Supreme Court
for a term of two years, upon submission of three (3) names by the
Idaho State Counselors Licensing Board or appropriate association,
(E) A psychologist appointed by the Supreme
Court for a term of two years, upon submission of three (3) names
by the Idaho State Board of Psychologist Examiners or appropriate
association, and
(F) A psychiatrist appointed by the Supreme Court
for a term of two years, upon submission of three (3) names by the
State Board of Medicine or appropriate association.
(2) Powers of Advisory Board. The Domestic Assault
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and Battery Evaluator Advisory Board shall have the power to make
the following recommendations to the Supreme Court:
(A) Recommend qualifications and continuing
education of evaluators under Rule 33.3(a),
(B) Review and recommend for appointment
approval or rejection applications of persons to be evaluators under
this rule.
(C) Recommend the required content and scope
of reports of evaluators under this rule,
(c) The scope and content of the evaluator's report shall be as
follows:
(1) Identifying information.
(A) Name
(B) Address
(C) Date of Birth
(D) Occupation
(E) Current Incident
(F) Marital Status
(G) Children
(H) Military Service
(2) Risk Assessment
(A) Current and past violent behavior
(B) Exposure to violence
(C) Threats of homicide/suicide/violence
(D) Ideation of homicide/suicide/violence
(E) Weapons access
(F) Obsessed with or dependent upon victim (Sociopathic
Traits)
(G) History of rage and impulsivity
(H) History of sexual abuse (perpetrator or
victim
(I) History of child abuse (perpetrator or victim)
(J) Access to victim
(K) Criminal record
(L) Cultural issues
(M) History of domestic violence protection orders
(N) Prior treatment for aggressive violence
(O) Danger of reoffending
(3) Substance Abuse
(A) Present usage of drugs
(B) Prior treatment for drug abuse or addiction
(C) Involvement of substance abuse in incident
(D) Assessment
(4) SelfͲAssessment
(A) Description of current incident in person's own words
(B) Person's acceptance of responsibility for incident
(C) Remorse evidenced by person
(D) Person's own view of need for treatment
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(E) Person's willingness to get treatment
(5) Test Results (If any Ͳ substance abuse testing,
psychological testing , I.Q., etc.)
(6) Collateral information
(A) Police report
(B) Victim interview
(C) Prior treatment ͲͲ review of past records
(7) Personality/character assessment
(8) Behavioral observations/mental status
(A) Level of cooperativeness
(B) Appearance
(C) General present mental status
(9) Recommendation
(A) A summary formulation that identifies the factors
causing and/or contributing to the defendant’s domestic
violence that form the basis for the evaluator’s opinion
as to the treatment recommendation
(B) Further assessment opinions and if needed
(C) Treatment recommendations
(D) Providers available to treat
(E) Cost of treatment (estimate)
(F) Cost of alternate treatment
(G) Resources available to defendant
(d) In the event the evaluator submits an evaluation that is not in compliance
with subsection (c) of this rule, the court may return the evaluation with
instructions to prepare an evaluation in compliance with the rule at no
additional cost to the defendant. In the event an evaluator fails to submit
an evaluation in compliance with this rule after such an instruction, the court
may forward the evaluation to the Board as a sealed confidential document along
with a written request that the evaluator be removed from the roster for failure
to comply with the rule. If the Board determines the evaluation fails to meet the
requirements of the rule, the evaluator may be removed from the roster.
(Adopted effective August 8, 1995; amended August 23, 1996; effective
November 1, 1996; amended January 30, 1997, effective February 1, 1997;
amended August 3, 1998, effective August 4, 1998; amended March 9, 1999,
effective July 1, 1999; amended January 30, 2001, effective July 1, 2001;
amended April 22, 2004, effective July 1, 2004; amended May 22, 2006,
effective July 1, 2006; amended March 21, 2007, effective July 1, 2007;
amended April 4, 2008, effective July 1, 2008)
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