<p> LIFER HEARINGS CLIENT INFORMATION SHEET</p><p>1. PERSONAL/FAMILY INFORMATION</p><p>Client:______Inmate No.______Hearing Date/Time:______Olsen Review: Y/N Waived Date:_____ DOB:______POB:______INS Hold: Y/N Significant medical issues: Yes No ______In EOP: Yes No. If yes, since: ______Past EOP: Yes No. If yes, date(s)______In CCCMS: Yes No. If yes, since:______Past CCCMS: Yes No. If yes, date(s)______</p><p>Parents/Children/Siblings/Spouse/Signif Other:______Any contact, support letter concerns issues?______2.COMMITTMENT OFFENSE(S):______</p><p>NON-CONTROLLING:______</p><p>Date(s):______County:______Sentence:______Victim(s)______</p><p>Age Then:___ Age Now:___ Jail/CYA time:______Life Term began______Other term began: ______</p><p>Classification Score/Security Level Then:______Now:______MEPD: ______Convicted by: ___Jury___ Plea If Plea issues re terms______“Official Version” of Crime: from ___Probation Report___ Appellate Opinion__ Other</p><p>______</p><p>______</p><p>If both POR and App Opinion, Significant Differences: ______IM’s Most Recent Version of Crime: from Board Report ____ Psych Eval ___ IM written statement_____</p><p>______</p><p>Differences between IM’s most recent version and older versions ______WAS LIFE CRIME COMMITTED AS A RESULT OF SIGNICANT STRESS IN IM’S LIFE Yes No If yes, facts demonstrating:______</p><p>3. PREVIOUS CRIMINAL RECORD: Juvenile: Yes No Date/Crime(s)/Disposition______Adult: Yes No Date/Crime(s)/Disposition______</p><p>4. EMPLOYMENT Current Job/How Long:______Exceptional/Above Average/ Satisfactory</p><p>Signif Prior Jobs: ______</p><p>Vocations/certifications):______</p><p>PRE-INCARC WORK/MILITARY HIST: ______</p><p>5. EDUCATION: Pre incarc:______</p><p>In prison:______</p><p>6. CHARITY/VOLUNTEER ACTIVITIES: ______7. KEY LAUDATORY CHRONOS:______8. PRISON DISCIPLINE: _____ 115s: date/violation (most recent/especially serious)______for violence ______for alcohol/drugs ____ mitigating factors: ______128s: date/violation (most recent) ______Does I/M have a ___ 602 ___ writ pending on a 115/128 If yes, status: ______</p><p>9. SELF HELP/THERAPY PROGRAMS Psychological:______SAP: ___ general: ______AA/NA: ______Anger Management:______Victim Awareness:______Religious:______Other:______10. PAROLE PLANS: Residence: Name/Relationship/City/County______Alternate Residences:______Job Offer: Company/City/County ______Job Title/Description/Salary:______Alternate Job Offer(s)Plans:______SSI/Disability/Inheritance/Pension/VABenefits/Pledged Support/SAP Sponsor/Counselling/Other Plans: 11. SAP/GANG ACTIVITY CLEAN & SOBER DATE:_____ Inconsistent/minimizing statements re past/pres SAP______GANG AFFILIATION: Pre-Incarc ____ In Prison ___ Year Ended ___ Year Debriefed ___ IM inconsistent/minimizing statements re past/present gang involvement ______</p><p>12. LAST/SIGNIF PRIOR PAROLE HEARINGS</p><p>Date:______Grant: Yes No Denied_____ years Waiver/Stip to unsuitability Yes No</p><p>If yes, reasons hearing was waived/stipulated: ______</p><p>If hearing was postponed, reasons:______This was IM’s ______parole hearing a) Grounds for denial: ___ Life Crime; ___ Prior Criminal Record; ___ USH; ___ discipline issues; ___ parole plans issues; ___ insufficient SH/T; ___ failure to upgrade educationally/vocationally ___ I/R/R ___ psych evalnot [totally] supportive ____ DA/PD/V-VNOK opposition ___ other ______</p><p>Details:______Recommendations: __ Become/remain disciplinary free Upgrade: __ Vocationally __ Educationally __ Improve parole plans Particip in __ SH __ T ___ New Psych Eval ___ Improve I/R/R __ Try to reduce security classification __ Earn positive chronos ___ Other ______</p><p>Relevant Prior Parole Hearings: ______</p><p>Was IM Given Parole Date That Was ___Reversed By Gov ___ Rescinded by Board If Yes: Date/Reasons ______Does I/M have a writ pending? If yes, status ______14. PSYCHOLOGICAL EVALUATION(s)</p><p>Current: By:______Date:______Overall Favorable: Y/N Risk Rating:______</p><p>______Flaws w/DSM IV Diagnoses Y/N If Yes Why:______Flaws w/Risk Rating/Test Scoring Y/N If Yes Why:______Should IM have Independent Psych Eval Y/N If Yes Why:______</p><p>Prior evals: ______</p><p>______Consecutive “low” or “equal to average citizen” risk ratings _____ since ______Indep Psych Eval By:______Date:_____Overall Favorable: Y/N Risk Rating:______</p><p>______</p><p>14. If YOPH eligible, Significant Hallmarks of Youth: ______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>15. EVIDENCE OF INSIGHT, RESPONSIBILITY, REMORSE _Psych eval year___pp_____I R R year___ pp_____I R R year___ pp _____I R R year___ pp____I R R year___ pp____I R R year___ pp_____ I R R year ___ pp_____ I R R year ___ pp_____I R R___ _Prior hearing decisions: year___ pp____ I R R year___ pp_____ I R R year___ pp_____ I R R _ Bd Rpt/POR Low Risk of Violence/IR&R year___ pp____ L I R R year ___ pp____ L I R R Does IM have:__IRR statement__VNOK letter__ RPP __ Gang Involvement Statement __ 115 Statement</p><p>16. MATRIX/BASE TERM CALCULATION: ______Good time credit issues______</p><p>17. PRE-INMATE INTERVIEW TO DO’S/IMPRESSIONS/NEEDS/STRATEGIES Chances of obtaining parole date: Excellent Good Fair Poor Non-Existent Should IM __waive ___ stipulate __ postpone Yes No Uncertain If Yes, reason(s): Predicted Range of Outcomes: Grant_____ D-3____ D-5____ D-7____ D-10____ D-15____</p>