In order to measure outcomes of court ordered referrals to certified Batterer Intervention Programs, the Department of Corrections is requesting that each BIP submit statistics on a monthly basis.

* Note: fields marked with an asterisk (*) MUST be filled in.



Reporting Period
  (Please enter all four digits, e.g 2009)




Number of non-white participants from each culture


Incoming Referrals


Special Needs
  • What accomodations, if any, were made within the program for example, for men for whom English was a second language, men from a different culture, hard of hearing, or who had difficulty being in a group?

Special Need
Number of Men
Describe Accomodations Made
English as Second Language

Hearing Impairment
Mental Illness
Total Number of Men with Special Needs*


Number of referrals to each service


If you have questions about completing this form, contact Denise Giles by phone at 800 968 - 6909 or by email to: DENISE GILES

When you have completed this report, click the SUBMIT button to send it to the Department of Corrections. Press RESET to clear your entries and start over.