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If you are requesting an FSA Analysis OR a PATTERN Risk Score, please include the following:
Name of Individual:

Inmate Number:

Date of Arrest:

Date Sentenced:

Date Committed::

Any Prior Time:

Sentence Length:

Crime of Conviction (not Indictment):

Number of Prior Convictions:

Any Incident Reports (if in prison already):

Date Since Last Incident Report:

Any History of Violence:

Any Escape Attempts:

High School Diploma/GED Y/N:

Drug Education Need in PSR/RDAP Recommendation: