Name
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First Name
Last Name
Email
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Where were you raised?
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How would you describe your mom and your dad - general personality, job and so forth ?
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Give me 2-4 sentences on this topic
What was your family life like when you were a child through your teen years?
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Try to write at least 6 sentences for this answer
Who did you live with when growing up?
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Were you exposed to alcohol or/ and drug abuse as a youth?
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If yes, give me 4-6 sentences on this topic
Were you abused sexually, physically or emotionally as a child? If so, please describe the situation and at what age it occurred.
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If yes, give me at least 4 sentences on this topic
Was there anything about your family life or upbringing that you believe contributed to your crime/s?
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If yes, give me at least 4 sentences on this topic
Did you attend college? If so, please explain.
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What has your career path been like?
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Did you use drugs or abuse alcohol during your adult life?
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If yes, give me at least 4 sentences to explain
What is your current family and living situation like i.e. are you married, do you have children and so forth?
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Describe your crime, including circumstances leading up to commission of the crime.
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Give me at least 8 sentences on this topic
What negative feelings have you experienced as a result i.e. shame, remorse, regret and so forth? - Describe with detail.
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Give me at least 8 sentences on this topic
What have you been doing to better your mindset and your life since your arrest (community service, volunteering, coaching, attending church, meeting with positive mentors or so forth)?
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What are your plans after release from prison, should you be incarcerated for this crime?
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Give me 3-6 sentences on this topic
Are you committed to using your time, free or in prison, to better your self and never go down this path again?
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Yes
No
Do you accept that you must be held accountable for your crime?
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Yes
No
What is one lesson you’ve learned through this ordeal?
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Give me 3-6 sentences on this topic