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Menu
WHO WE ARE
Our Team
News & Press Releases
Community Connections
Media Kit
Contact Us
TRAINING & CLASSES
Adults
Youth
Organizational Workshops
Restorative Practices
Training Options for Schools
Training Options for Individuals
Restorative Parenting
Restorative Denver Training
Register for a Class
PROGRAMS
COMMUNITY PROGRAMS
Rethinking Conflict: Youth Class
Restorative Denver/Restorative Justice
Find Just the Right Resources for Restorative Contracts
Restoring Peace: Practical Tools for Parents and Families
SCHOOL PROGRAMS
Hot Spot Mapping
Rethinking Conflict: Youth Class
Building Healthy Relationships/Social Norming
Reading for Peace
RESTORATIVE PRACTICES
Training Options for Schools
Training Options for Individuals
RESOURCES
Original Resources
Blog
Annual Report & Financials
GET INVOLVED
Donate
Youth Advisory Board
Become a Volunteer
Become an Instructor
Internship Program
Community Events
Join Our Team
DONATE NOW
DA Pre-Process Screening
Case ID Number: (No symbols, numbers only)
*
Date
*
MM slash DD slash YYYY
1. Who was harmed in your case?
2. Did you know the victim before the offense?
Yes
No
There was no direct victim
3. If yes, how did you know them?
4. My offense harmed the victim:
1 Not at All
2
3
4 Somewhat
5
6
7 Very Badly
5. Please mention HOW you think your offense harmed the victim:
6. My offense harmed the community:
1 Not at All
2
3
4 Somewhat
5
6
7 Very Badly
7. Please mention HOW you think your offense harmed the community:
8. My offense harmed my family:
1 Not at All
2
3
4 Somewhat
5
6
7 Very Badly
9. Please mention HOW you think your offense harmed your family:
10. My offense harmed me:
1 Not at All
2
3
4 Somewhat
5
6
7 Very Badly
11. Please mention HOW you think your offense harmed you:
12. What do you think could be done to repair the harm caused?
Please answer the following questions by circling the number that best describes how you feel right now on a scale of 1 to 7. Please answer as honestly as possible.
13. Right now, how do you feel about yourself?
1 Awful
2
3
4 Neutral
5
6
7 Happy With Who I Am
14. Right now, how do you feel about what you've done?
1 Doesn't Bother Me At All
2
3
4 Neutral
5
6
7 Can't Stop Thinking About It
15. Right now, how much do you worry about what other people think of you?
1 Not at all
2
3
4 Somewhat
5
6
7 Very much
For the most part, how much do you agree with the following statements currently:
16. I have done something that needs to be made right:
1 Not at all
2
3
4 Somewhat
5
6
7 Very much
17. I feel like my community cares about me:
1 Not at all
2
3
4 Somewhat
5
6
7 Very much
18. My case is being handled fairly:
1 Not at all
2
3
4 Somewhat
5
6
7 Very much
19. What do you hope will happen during the Restorative Justice process?
X
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