Aa Na Attendance Form PDF
ATTENDANCE FORM FOR ALCOHOLICS/NARCOTICS ANONYMOUS MEETINGS NAME: SUPERVISION OFFICER: The above captioned individual is required by his supervision conditions to attend Alcoholics Anonymous meetings.
Revised 5/01 AA - NA Attendance DEFENDANT’S NAME OFFICER’S NAME The following record is a true representation of the AA/NA meeting(s) that I have attended.
ATTENDANCE FORM FOR ALCOHOLICS/NARCOTICS ANONYMOUS MEETINGS NAME: SUPERVISION OFFICER: _____ The above captioned individual is required by his supervision conditions to attend Alcoholics Anonymous meetings.
Meeting Attendance Verification Name: _____ Date/Time:_____/_____ Circle one: (AA, NA, CA) Meeting: _____ Location:_____
Attendance Form for Alcoholics/Narcotics Anonymous or Independent Outpatient Meetings. Full Name Department Job Title Supervisor University ID The above named individual is required to attend these meetings.
arizona state board of nursing 4747 north 7th street, suite 200 phoenix, arizona 85014-3655 (602) 771-7865 fax (602) 771-7882 aa/na attendance report
AA Attendance Record It is your responsibility to attend at least AA meetings per week. This form is to be brought back to the U.S. Probation Office each week that you are in treatment.
Attendance Record for Alcoholics or Narcotics Anonymous Meeting/Alcohol Awareness Class Name: _____ Case No. _____ The above named individual is required by the terms of his Occupational Driver’s License to attend Alcoholics/Narcotics Anonymous
12 Step Meeting Attendance Sheet AA/NA/CA/DRA/GA Name: _____ Phase :_____ Week of: _____ Date Group Chairperson Time Signature: _____ Date: _____ * Phase I & II ...
MEETING ATTENDANCE LOG AND PROGRESS REPORT . ... Address_____ Phone: _____ Date Time AA, NA, Peer Specific Group Name Topic (Be Specific) Sponsor First ... (Please use the back of this form if needed for further documentation)
A.A./N.A./C.A. ATTENDANCE VERIFICATION NAME _____ IS TO ATTEND A MINUMUM OF _____ MEETINGS PER WEEK Directions : Fill in date & time then at the beginning of meeting, hand this form to chairperson or secretary so at the
Please do not sign this form until the completion of the meeting. Your cooperation in this matter is appreciated. Defendant Name:_____ DATE GROUP CHAIRPERSON/PHONE # OPEN/CLOSED MEETING ... Microsoft Word - AA NA Attendance Record
Please return to: NA World Services, PO Box 9999, Van Nuys, CA 91409 -9099 USA This form is also available on our website – www.na.or g. ON-LINE MEETING FORM
General: AA-Alcoholics Anonymous Specific: ... NA-Narcotics Anonymous RECOVERY PROGRAM MEETING ATTENDANCE LOG *Types of meeting (indicate both general and specific type): Title: Recovery Program Meeting Attendance Log.xls Author: hprather
MONITORING - AA/NA ATTENDANCE REPORT NAME: TIME PERIOD COVERED BY THE REPORT: FROM:_____TO:_____ SPONSOR’S NAME: SPONSOR ... Below, and on the other side of this form, LIST ONLY AA/NA/CA meetings, the date you attended, and
aa/na/support group or aftercare meetings report • nurse’s name: • group name: • group location: • date attended:
meetings of Alcoholics Anonymous/Narcotics Anonymous. We do not verify a chemical-free state. We verify attendance only. ... PROOF OF ATTENDANCE AT AA/NA MEETINGS DATE NAME AND LOCATION OF GROUP NAME OF SIGNER TELEPHONE # Title: TO WHOM IT MAY CONCERN:
Attendance Verification Sheet _____ is to attend AA/NA meetings as ordered by the Judicial District Community Supervision and Corrections Department.
Monthly Attendance Verification - Self-Help Meetings 1 of 1 www.hprp.org ... This form is used to verify that I have attended the following self-help group meetings (AA, NA, Caduceus, Al-Anon, Nar-Anon, etc.)
Verification of Meeting Attendance Student Name _____ PID# _____ _____ Date/Time of Meeting _____ Meeting Location ... Verification of Meeting Attendance (AA, NA, MA)
— Tradition Three (the long form) “Each Alcoholics Anonymous group ought to be a spiritual entity having but one primary purpose — that of carrying its message to the alcoholic who still suffers. ...
S.A.R.P.H. SUPPORT GROUP ATTENDANCE SHEET NAME:_____ Due by the 10th of each month. AA/NA, ALANON/ACOA, ETC
Form CDD-104 Revised 1/2006 School Name County-District-Campus No. (If Applicable) Verification of Enrollment and Attendance (VOE) Form Planned Use of Data: To provide documentation of enrollment and attendance status to the Texas Department of Public Safety (DPS) for a
AA/NA/GA VERIFICATION SHEET Due to your special condition(s), you are required to attend one (or ____ ) AA, NA or GA meetings per week. You must have the secretary of the meeting sign this form AFTER THE
United States District Court Probation Office District of Wyoming NA/AA VERIFICATION OF ATTENDANCE Name: _____ Month: _____
client have this form completed and signed by ... or Secretary at each meeting attended. Please return this form to the client at the close of the meeting. AA: (408) 374-8511 [www.aasanjose.org]; NA: (408) 998-4200 [http ... * You are to provide proof of meeting attendance during the first week ...
Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment
support group attendance form (please make sufficient copies for your use) participant: _____ reporting month(s)_____ no. of support groups [aa, na, ca, al-anon] mtgs per week: _____ no. of nurse support group mtgs. per week: _____ sunday: - saturday ...
Information on Alcoholics Anonymous For Anyone New Coming to A.A. ... This proof of attendance at meetings is not part of A.A.Hs procedure. Each group is autonomous and has the right to choose whether or not to sign court slips.
program if I falsify an AA/NA attendance sheet or community services form. True False 21. If I relapse, I will be required to start Phase II again. True False 22. I am ... (Narcotics Anonymous or Alcoholics Anonymous). The length of the Drug Court Program is
Table 4.3 Attendance of AA/NA Meetings and Abstinence from ... Alcoholics Anonymous and Narcotics Anonymous meetings, rather than the entire ... AA/NA meetings and abstinence form alcohol and/or drugs within the demographics of
REP Meeting Attendance Forms ... (AA, NA) o Sponsor meetings o Group meetings (IOP, relapse prevention, aftercare or other treatment or group ... attending, have an AA group member or your sponsor sign the form verifying your participation.
COMPLIANCE DIVISION NAME_____ REPORT FOR THE MONTH _____, 20_____ This form may be used to document your weekly attendance at AA/NA meetings.
AA/NA MEETINGS-ATTENDANCE FORM . TO WHOM IT MAY CONCERN: _____ is encouraged to attend AA/NA meetings in the community so that he/she might have the opportunity to meet and converse with others persons who have alcohol or substance ...
Alcoholics Anonymous is a fellowship of men and women who share their ... attendance, nor does A.A.provide the card or form you might need. If a meeting chairperson or group member offers to sign your court card,
SUPPORT GROUP ATTENDANCE FORM ... REPORTING MONTH: _____ # of mtgs. per Month AA, NA, CA, AL-ANON Day Support Group Type Location Date Time Signature (1st name, last initial) chairperson or facilitator Chairperson or Facilitator’s phone ...
Monthly Group Attendance Report – Substance Use Disorder ... (Examples: AA, NA, CA, SA, Al-Anon, CODA, etc.) ... (Please fax this form to 804-828-5386 by the 10 th of the month. Thank you for your cooperation!) For Office Use Only:
Meeting attendance cards (CHITS) ... example where these form part of a Drug Treatment and Testing Order (DTTO). In accordance with our Traditions and with NA World Services suggested policy, and in the light of the positive experience of both AA and NA around the world, ...
J. AA/NA attendance reported: Y N N/A K. Any known alcohol or drug use: Y N N/A L. Compliant with treatment: Y N . M. Anticipated date of completion of ... Signature Date. Title: Psychiatrist/Addictionist Monthly Report Form Author: BARBARA MORVANT
The defendant shall attend a minimum of two (2) 12-step self help group meetings (AA, NA, etc.) per week and provide written proof of such attendance to the court at each court hearing; 2. The defendant shall comply with all court orders including Orders of Release;
H. AA/NA attendance reported: Y N N/A . I. Any known alcohol or drug use: Y N N/A . J. Compliant with treatment: Y N K. Anticipated date of completion of ... Therapist/Counselor Report Form Author: BARBARA MORVANT
schedule of AA/ NA meetings in Kitsap County and reporting forms may be obtained at the ... proof of attendance filed with the Court on a court-approved form. DEFERRED PROSECUTION -- PROCEDURES:
83706), fax (208-323-9222), and/or email your monthly attendance form to the PRN office. Please be aware that a low meeting non-compliance letter will go ... o Mutual Support Groups (i.e. AA, NA or other 12 step) o Sponsor meetings o Group meetings (i.e. IOP, relapse prevention, ...
NAME: Report for Month of: This form may be used to document your weekly attendance at AA/NA meetings. You will need to provide the following information:
• Most will require or encourage AA/NA attendance • An often _____ • Often passionate reactions Alcoholics Anonymous • Established June ... – there is _____ form of alcoholism – moderate drinking is impossible for everyone – alcoholics should be labeled, confronted ...
meeting AttendAnCe NA members find that regular meeting attendance helps ... to form relationships with other recovering addicts and ... Narcotics Anonymous is not affiliated with these organizations, ...
FORM W/SURGICAL ASSISTANT ... • AA/NA attendance records. Note on Mental, Physical, Neurological Conditions: The Board understands that medical or mental health treatment is a normal part of many person's lives and such treatment does not
of AA/NA meeting attendance but by law cannot accept them as program treatment hours). Form Completed By: ... *Please note that this form is not 'official'. It is optional on your part, designed to provide me the specific dates
Use this form only to request group or individual therapy for substance use disorders. For any mental health treatment requests, ... Outside AA/NA Attendance* None 1-4/Week > 4/Week Sponsorship* Nome Temporary Permanent Skill ...
and return this form with YES or NO response to: Ted Wiggins, Drug Court Coordinator . 735 James Brown Blvd. Suite 2200 . Augusta, Georgia 30901 ... AA/NA 7x per week with proof of attendance ...