BATTERER INTERVENTION PROGRAM DATA

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.

Name of Person Submitting Report

Report Period* (please format as mm/yyyy - e.g. 01/2005)

Telephone number

Email address

Enrollment

Number of intakes

Number currently enrolled*

Number terminated

Number of re-admissions

Number of new intakes who have previously completed or been enrolled in the program

Number of non-white participants from each culture

Asian

Black

Hispanic

Native American

Total number non-white participants

Number of referrals to each service

Substance Abuse

Literacy

Parenting

Mental Health

Vocational

Employment

Housing

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, or press RESET to clear your entries.

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