Correctional Rehabilitation Consultants * Interpersonal Relationships Inventory
Check each box that honestly applies. Your unbiased responses will not be disclosed to the Unique client.
Email address *
What is today's date? *
What is your full name, phone number, and address? And what is your relationship to the person needing our assistance?
The following questions refer to the person in need of our assistance who is in jail, prison, on parole, or on probation (or headed in that direction). We refer to that person as the Unique Client. Please provide the person's name, date of birth, jail number, prison number, attorney's name, probation or parole officer's name, name of jail or prison they are in, and the city, county, and State they are located in:
Does the Unique Client live in a neighborhood that is considered a high crime neighborhood? *
Does the Unique Client has Social Support? *
Would you describe the Unique Client as: *
1. Is the Unique Client detached from the Family? *
Are there other family members in the household who have addictions or encounters with law enforcement? *
Does the Unique Client have the ability to show compassion and understanding for what others are going through? *
Does the Unique Client have a partner or significant other of positive influence known to the family? *
Does the Unique Client have positive friends they associate with regularly? *
Does the Unique Client have friends who commit crimes? *
Does the Unique Client have friends who abuse alcohol and or drugs? *
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