Name: ______

Date:______

7TH JUDICIAL DISTRICT ADULT TREATMENT COURT

PRE-GRADUATION QUESTIONNAIRE

Please answer the following questions completely. If you use a separate or additional piece(s) of paper, please rewrite the question before your answers. Only documents that are handwritten in black ink or type written on white paper will be accepted.

It is to your advantage to provide as much detail and information as possible.

  1. Describe your life prior to your entry into Treatment Court.
  1. Describe how your life is different today after the Treatment Court program.
  1. For what length of time have you been clean and sober?
  1. Describe how you will stay alcohol/drug free?
  1. Describe how you will remain crime free?
  1. Please describe, in detail, the following future goals:
  1. Two of your 90-day goals
  1. Two of your 6-month goals
  1. Two of your 1-year goals
  1. Do you have “life goals,” and if so, what are they?
  1. How do you intend to attain your “life goals”?
  1. Do you have a 12-step sponsor?
  1. How long have you had this sponsor?
  1. What step are you working on currently?
  1. How has having a sponsor been helpful to you?
  1. Describe your relationship with your sponsor?
  1. Besides your sponsor, describe your support system?
  1. What 12-step meetings are you attending?
  1. Do you intend to continue your involvement with a social support group?
  1. Describe any involvement that you have with the 12-step community (Volunteer, sponsor, etc.)?
  1. Where do you live? Who lives with you?
  1. Describe how your recovery has affected your relationship with others (include your husband/wife, children, parents, sisters/brothers, and close friends).
  1. How do you handle stressful situations now compared to when you were drinking and/or using drugs?
  1. Where are you currently employed?
  1. How long have you been employed/unemployed?
  1. Describe the kind of work that you do or could do?
  1. Is there room for advancement where you work?
  1. What are your educational plans or goals?

Suggestions for program improvement:

  1. What part of the Treatment Court helped you the most?
  1. What part of the Treatment Court helped you the least?
  1. What suggestions do you have for improving the Treatment Court?
  1. Other comments for the good of the program?

When you have completed your answers to these questions, please return the entire package, and your responses, to the Treatment Coordinator. Good Luck!

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