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Forms and Materials

Immersion A Point of Reentry

Participant Forms

  • pdf

    Participant Authorization for Release of Confidential Information

    Size: 114.03 KB
    Hits: 329
    Date added: 10-22-2021
    Date modified: 03-22-2023
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    Initial Contact Intake Form

    Size: 289.79 KB
    Hits: 366
    Date added: 10-22-2021
    Date modified: 03-22-2023
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    Notice of Decision

    Size: 115.84 KB
    Hits: 143
    Date added: 10-22-2021
    Date modified: 03-22-2023
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    Participant Information and Ongoing Contacts

    Size: 200.65 KB
    Hits: 146
    Date added: 10-22-2021
    Date modified: 03-22-2023
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    Participant Waiver and Release Form of Liability

    Size: 117.99 KB
    Hits: 163
    Date added: 10-22-2021
    Date modified: 03-22-2023
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    Program Participant File Checklist

    Size: 152.60 KB
    Hits: 137
    Date added: 10-22-2021
    Date modified: 03-22-2023
  • pdf

    LW-SSM Scoring Guide 1st Person Questions Only - Option 1

    Size: 819.13 KB
    Hits: 127
    Date added: 10-22-2021
    Date modified: 10-28-2021
    pdf

    LW-SSM Scoring Guide With Explanations - Option 2

    Size: 1.82 MB
    Hits: 106
    Date added: 10-22-2021
    Date modified: 10-28-2021
  • pdf

    SMART Goal Worksheet

    Size: 79.53 KB
    Hits: 111
    Date added: 10-22-2021
    Date modified: 03-22-2023
    pdf

    My 72-Hour Reentry Plan - A

    Size: 130.84 KB
    Hits: 112
    Date added: 10-22-2021
    Date modified: 03-22-2023
    pdf

    My 72-Hour Reentry Plan - B

    Size: 209.57 KB
    Hits: 98
    Date added: 10-22-2021
    Date modified: 03-22-2023
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    Participant Status Information

    Size: 134.89 KB
    Hits: 98
    Date added: 10-22-2021
    Date modified: 03-22-2023
    pdf

    Participant Financial and Voucher Assistance

    Size: 177.71 KB
    Hits: 119
    Date added: 10-22-2021
    Date modified: 03-22-2023
    pdf

    Participant Criminal Offense Information

    Size: 163.94 KB
    Hits: 119
    Date added: 10-22-2021
    Date modified: 03-22-2023

Volunteer Forms

  • pdf

    Background Check Waiver

    Size: 91.49 KB
    Hits: 234
    Date added: 10-22-2021
    Date modified: 03-21-2023
    pdf

    Health and Safety Disclaimer and Questionnaire

    Size: 133.38 KB
    Hits: 121
    Date added: 10-22-2021
    Date modified: 03-21-2023
    pdf

    Photograph, Video and Testimonial Release

    Size: 98.57 KB
    Hits: 117
    Date added: 10-22-2021
    Date modified: 03-21-2023
    pdf

    Staff Confidentiality Agreement

    Size: 93.30 KB
    Hits: 124
    Date added: 10-22-2021
    Date modified: 03-21-2023
    pdf

    Volunteer Application

    Size: 129.92 KB
    Hits: 340
    Date added: 10-22-2021
    Date modified: 03-21-2023
    pdf

    Volunteer Confidentiality Agreement

    Size: 97.12 KB
    Hits: 196
    Date added: 10-22-2021
    Date modified: 03-21-2023
    pdf

    Volunteer Forms Checklist

    Size: 124.09 KB
    Hits: 243
    Date added: 10-22-2021
    Date modified: 03-21-2023
    pdf

    Volunteer Notice of Decision

    Size: 110.06 KB
    Hits: 157
    Date added: 10-22-2021
    Date modified: 03-21-2023
    pdf

    Volunteer Employee Release of Confidential Information Authorization

    Size: 91.31 KB
    Hits: 177
    Date added: 10-22-2021
    Date modified: 03-21-2023
    pdf

    Volunteer Employee Contact

    Size: 96.03 KB
    Hits: 110
    Date added: 10-22-2021
    Date modified: 03-21-2023
    pdf

    Waiver and Release Form of Liability

    Size: 92.81 KB
    Hits: 140
    Date added: 10-22-2021
    Date modified: 03-21-2023
  • pdf

    Immersion Volunteer Manual

    Size: 319.78 KB
    Hits: 200
    Date added: 10-22-2021
    Date modified: 03-21-2023
    pdf

    Immersion Volunteer Manual Acknowledgement

    Size: 89.18 KB
    Hits: 134
    Date added: 10-22-2021
    Date modified: 03-21-2023
    pdf

    Volunteer Employee Training Documentation

    Size: 111.93 KB
    Hits: 132
    Date added: 10-22-2021
    Date modified: 03-21-2023
    pdf

    Activity Log

    Size: 90.38 KB
    Hits: 111
    Date added: 10-22-2021
    Date modified: 03-21-2023
    pdf

    SSM User Manual

    Size: 1.57 MB
    Hits: 117
    Date added: 10-22-2021
    Date modified: 10-28-2021
    pdf

    Immersion Site Procedure Manual

    Size: 742.27 KB
    Hits: 95
    Date added: 10-22-2021
    Date modified: 03-21-2023

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