WATCh EAST PROGRAM
700 Little Street
Glendive, MT  59330
Phone: 406.377.6001 Fax: 406.377.6004

Applicant Information Sheet

 PLEASE TYPE OR PRINT

 

THIS FORM IS TO BE COMPLETED BY THE INDIVIDUAL REFERRING AN APPLICANT TO
THE WATCh EAST PROGRAM

 Date:________________________

Applicant’s Name:____________________________    AO or SS#:_______________

Present Location of Applicant: _____________________________________________

Name and Title of Referring Individual:_______________________________________

Phone Number of Referring Individual:_______________________________________

Signature of Referring Individual:___________________________________________

 

Please attach to this Information Sheet any of the following items that are available:

ü      Judgment and Commitment papers.

ü      Initial Parole Board Report and Disposition.

ü      Probation/Parole Violation Reports.

ü      Current Medical Release from MSP or WCC Infirmary.

ü      FBI Rap Sheet.

ü      PSI Report

ü      Psychological Evaluation.

ü      Discharge Summaries from past treatment episodes.

ü      Basic Information Sheet.

ü      Actions taken by Sentence Review Board.

ü      Initial Classification Summary and Report.

ü      Summary of Unit Performance from MSP or WCC.

This Information Sheet and all supporting documents should be sent to:

WATCh EAST PROGRAM
 700 Little Street
Glendive, MT  59330 
Phone: 406.377.6001  Fax: 406.377.6004

 

 

 

 

 Back to Programs