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If you said 'yes' to the previous question, how many times have you been to prison?
 
1
 
2-5
 
>5
 
Not applicable
 
 
 
Rank the severity of the crime.
 
low (Simple Assault)
 
Moderate ( Theft/Robbery)
 
Severe (Rape/Murder)
 
 
 
Was a weapon used during the crime?
 
Yes
 
No
 
 
 
If 'yes', describe the weapon used.
 
 
Other
 
 
 
 
Do you regret committing the crime?
 
Yes
 
No
 
 
 
Were you working with someone?
 
Yes
 
No
 
 
 
What do you consider your gender to be?
 
Male
 
Female
 
Transsexual or Transgender
 
Other
 
 
 
What would you say prison has taught you?
 
 
Other
 
 
 
 
For what offense are you serving a sentence?
 
 
Other
 
 
 
 
What are your plans upon release?
 
 
Other
 
 
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