To be filled out by safe guard (use additional paper and number item if necessary)

The offender has read his Offense history to me with the treatment provider present ______________(initial).

1. The offender groomed or manipulated the victim in the following way(s):

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2. What were the positive qualities of the victim that the offender used to accomplish the grooming/manipulation:

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4. Can you anticipate any social, emotional, academic or other problems the victim may be having now or in his/her future as a result of the abuse by the offender?

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5. How is the offender currently taking responsibility for the damage he/she has done to the victim?

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6. How should the offender continue to take responsibility for the damage done to the victim in the future?

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7. Are there secondary victims of the offender's sexually deviant behavior? List who they are and why.

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8. Can the offender make reparation to these secondary victims and how can that happen.

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9. What has been the community's response to the victim that you are aware of?

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6. What has been the community's response to the offender that you are aware of?

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Signature:______________________________Date:______________________________