Domestic Abuse Intervention Program Client Situation Summary Client NameToday's Date MM slash DD slash YYYY The following information wil familiarize us with your view of your situation and offense. Thanks for helping us get to know more about you.Referring CourtOffense Date MM slash DD slash YYYY Charge Sentenced forWas any charge dropped or reduced? Yes No If yes, what chargeHad trial or Took a plea ? Had trial Took a plea Victim's name/relationship to youEmergency Contact Name and Phone NumberGIVE YOUR VERSION OF THE ARREST INCIDENT BELOW, BEING SURE TO INCLUDE THE ILLEGAL BEHAVIORS YOU USED:How much responsibility do you accept for this incident?Where did this happen?Why do you feel this way?Were you arrested on the spot? Yes No Who called the police and why?Who else was home ( or at the incident scene)?How has the incident affected your children?Amount of alcohol or drugs you had consumed in the previous 48 hoursDid alcohol or drugs influence your behavior? Yes No Did anything else influence your behavior? Yes No Are you still in a relationship with the victim? Yes No How often do you see the victim?What words best describe your relationship with the victim before the incidentWhat words best describe your relationship with the victim after the incidentWhat changes do you need to make to improve yourself or to avoid future incidents?What do you feel you can gain from attending this program Δ
