Aa Na Attendance Form PDF
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.
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.
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.
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
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
AA/NA neither endorses nor opposes any causes or organizations. PROOF OF ATTENDANCE AT AA/NA MEETINGS DATE NAME AND LOCATION OF GROUP NAME OF SIGNER TELEPHONE # Title: TO WHOM IT MAY CONCERN: Created Date:
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
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)
12 Step Meeting Attendance Sheet AA/NA/CA/DRA/GA Name: _____ Phase :_____ Week of:_____
AA Hotline 248.541.6565 AA Booklet Information 248.541.7490 ... Please do not sign this form until the completion of the meeting. Your cooperation in this matter is appreciated. ... Microsoft Word - AA NA Attendance Record Author:
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
n:\monitoring\forms\cna-forms\monitor-form-aa-na-cna.doc arizona state board of nursing 4747 north 7th street, suite 200 phoenix, arizona 85014-3655
attendance sheet month/year_____name:_____license #:_____ date time of day location type: ca, aa, na chairperson sign or initial required: sponsor comments on step work/progress/ other: comments ...
Microsoft Word - Verification of Meeting Attendance (AA, NA, MA) Author: btwhite Created Date: 8/21/2012 11:23:43 AM ...
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
Miami-Dade County Drug Court Program . DEFENDANT’S PROOF OF 12 STEP PROGRAM (NA/AA) ATTENDANCE . As a condition of my participation in the Miami-Dade Drug Court Program, I,
aa/na/support group or aftercare meetings report • nurse’s name: • group name: • group location: • date attended:
S.A.R.P.H. SUPPORT GROUP ATTENDANCE SHEET NAME:_____ Due by the 10th of each month. AA/NA, ALANON/ACOA, ETC
This form is used to verify that I have attended the following self-help group meetings (AA, NA, Caduceus, Al-Anon, Nar-Anon, etc.) ... It only verifies attendance at the listed meetings.
United States District Court Probation Office District of Wyoming NA/AA VERIFICATION OF ATTENDANCE Name: _____ Month: _____
Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment
By Fax: 212-870-3003 (Attn: Records) E-mail: email@example.com Grand Central Station P.O. Box 459 New York, NY 10163 FOR G.S.O. RECORDS DEPT. USE ONLY ... F-30 Alcoholics Anonymous New Group Form Author: A.A. World Services, Inc. Created Date:
Attendance Verification Sheet _____ is to attend AA/NA meetings as ordered by the Judicial District Community Supervision and Corrections Department.
NAME_____ REPORT FOR THE MONTH _____, 20_____ This form may be used to document your weekly attendance at AA/NA meetings.
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 ...
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.
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
ATTENDANCE FORM FOR ALCOHOLICS/NARCOTICS ANONYMOUS MEETINGS ... Free AA Meeting Attendance Sheet Den Meeting Attendance Sheet 12 Step Meeting Attendance Sheet. Title: generic meeting attendance sheet - Bing Created Date: 2/15/2014 8:47:46 PM ...
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
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 ... Attendance will be required at 12-step meetings such as Narcotics Anonymous and Alcoholics Anonymous. The MINIMUM attendance requirement for the ...
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 ...
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
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
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, ...
Reimbursement Form Sign Up Sheets Timesheet Template Vacation Tracker Work ... Alcoholics Anonymous meeting on ... ... AA / NA MEETING ATTENDANCE SHEET NAME: ... A Simple Meeting Sign-in Template | Sign in Sheets
and return this form with YES or NO response to: ... AA/NA 7x per week with proof of attendance . Counseling/Treatment Sessions 2x per week . Drug Screens 3x per week . Breathalyzer upon request • Employment, School, or vocational training.
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:
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 ...
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;
• 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 ...
Narcotics Anonymous has grown a great deal since 1953. ... there was no NA. I found AA, and in that fellowship met addicts who had also found that program to be the answer to their problem. ... and I do believe that my daily attendance at
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 ...
Alcoholics Anonymous Narcotics Anonymous Self-help Groups Adolescent abstract ... predicted by a goal of abstinence, prior AA/NA attendance, and prior SUD treatment experiences. ... and Form-90 (Miller and Del Boca, 1994) ...
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:
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, ...
AA NA OTHER _____ ATTENDANCE: Regular or Sporadic *MEDICAL ISSUES: West Slope Casa Medical ... Microsoft Word - WSC RESIDENTIAL SCREENING Form 8-06.doc Author: sally Created Date: