RA Monthly Check-in with Offenders

What is today's date?

Month	Day	Year

Offender ID:

Interviewer Initials:

1. In the last month/ last time we spoke has any of you contact information changed?

[,]

If yes, please specify or provide updated information

Yes

No

Don't Know

Refused

a. Phone Number

b. Address

c. Email or social network

d. Employment Status

e. Housing Situation

f. Education Status

g. Legal Status

h. Other

2. In the last 30 days/week/since last time we spoke did you use the workbook?

Yes

No

2b. Why did you not use the workbook? (please specify)

3. Do you like using the workbook?

Yes

No

3b. Why do you like using the workbook? (please specify)

3c. Why do you not like using the workbook? (please specify)

4. What sections in the workbook are you working on?

5. Have you completed any checklist items or tasks?

Yes

No

Don't Know

Refused to Answer

5b. What checklist items or tasks have you completed?

6. Any accomplishments you would like to share since the last time we spoke?

7. In the last 30 days/since last time spoke are you experiencing any setbacks/challenges?

Yes

No

7b. Please specify setbacks or challenges experienced

8. In what ways do you feel like you can communicate with your supervising officer?

9. What are your impressions of your officer?