To be filled out by safe guard. (Use extra paper if needed and attach)

1. Describe, using appropriate terminology, the offender's offense(s).

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2. Describe any incidents of sexual abuse that have been founded by SRS.

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3. Describe the offender's sexual abuse cycle.

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4. What SUD's (Seemingly Unimportant Events) led up to the offender's deviant behaviors and offense?

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Signature: _________________________________________

Date: _________________________________________