VALLEY STATE PRISON FOR WOMEN
INMATE FAMILY COUNCIL MEMBER APPLICATION
INMATE FAMILY COUNCIL MEMBER APPLICATION
Visitors who are interested in becoming a member of the Valley State Prison for Women (VSPW) Inmate Family Council are encouraged to submit an application. The committee will meet regularly with VSPW staff to discuss matters that affect family members. Meetings are held bi-monthly and scheduled on the first Friday of each scheduled month. The Council is comprised of a cross-section of family members and/or others who have a significant relationship with an inmate at VSPW. All applicants must be approved visitors of VSPW prior to any appointment.
If you are interested in becoming an Inmate Family Council member, print this out, complete the application and send it to the VSPW Administrative Assistant, Lt. Jim Neeley, P.O. Box 99, Chowchilla, CA 93610-0099. (559) 665-6100.
All information will be considered “CONFIDENTIAL,” and only used in the selection process.”
If you are interested in becoming an Inmate Family Council member, print this out, complete the application and send it to the VSPW Administrative Assistant, Lt. Jim Neeley, P.O. Box 99, Chowchilla, CA 93610-0099. (559) 665-6100.
All information will be considered “CONFIDENTIAL,” and only used in the selection process.”
YOUR NAME:___________________________________________________________
(LAST, FIRST, MIDDLE)
INMATE NAME:_________________________________________________________
(LAST, FIRST, MIDDLE)
INMATE CDC#______________________FACILITY __________________________
RELATIONSHIP TO INMATE:_____________________________________________
WHERE YOU CAN BE CONTACTED: TELEPHONE#__________________________
E-MAIL ADDRESS_____________________
ADDRESS______________________________________________________________
(STREET, CITY, STATE, ZIP)
QUALIFICATIONS/REASON(S) FOR APPLYING:____________________________
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Questions? Call Lt. Jim Neeley, Administrative Assistant, at (559) 665-6100, extension 6161
(LAST, FIRST, MIDDLE)
INMATE NAME:_________________________________________________________
(LAST, FIRST, MIDDLE)
INMATE CDC#______________________FACILITY __________________________
RELATIONSHIP TO INMATE:_____________________________________________
WHERE YOU CAN BE CONTACTED: TELEPHONE#__________________________
E-MAIL ADDRESS_____________________
ADDRESS______________________________________________________________
(STREET, CITY, STATE, ZIP)
QUALIFICATIONS/REASON(S) FOR APPLYING:____________________________
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Questions? Call Lt. Jim Neeley, Administrative Assistant, at (559) 665-6100, extension 6161
VALLEY STATE PRISON FOR WOMEN
INMATE FAMILY COUNCIL
VOLUNTEER AGREEMENT
INMATE FAMILY COUNCIL
VOLUNTEER AGREEMENT
VOLUNTEER:
NAME:_________________________________________________________________
ADDRESS:______________________________________________________________
______________________________________________________________
______________________________________________________________
PHONE:________________________________________________________________
The following are the conditions accepted under this agreement according to current policies, rules, procedures, and regulations of the California Department of Corrections.
1. Comply with policies, procedures, rules, procedures and regulations of the Department of Corrections.
2. No salaries, wages, employment benefits, Worker’s Compensation or special privileges will be received for participation.
3. Use of State supplies and equipment is prohibited.
4. Participation as a member of the Inmate Family Committee is non-binding and may be terminated at any time by the Institution or Council Member.
5. I understand that there will be no discussion of personal grievances during meetings. Personal experiences may only be used as examples to illustrate a larger problem.
Period of agreement beginning: ________________ 20
____________________________ __________________
SIGNATURE OF MEMBER DATE
Reviewed and approved by appropriate authority:
WARDEN (DESIGNEE) _____________________
NAME:_________________________________________________________________
ADDRESS:______________________________________________________________
______________________________________________________________
______________________________________________________________
PHONE:________________________________________________________________
The following are the conditions accepted under this agreement according to current policies, rules, procedures, and regulations of the California Department of Corrections.
1. Comply with policies, procedures, rules, procedures and regulations of the Department of Corrections.
2. No salaries, wages, employment benefits, Worker’s Compensation or special privileges will be received for participation.
3. Use of State supplies and equipment is prohibited.
4. Participation as a member of the Inmate Family Committee is non-binding and may be terminated at any time by the Institution or Council Member.
5. I understand that there will be no discussion of personal grievances during meetings. Personal experiences may only be used as examples to illustrate a larger problem.
Period of agreement beginning: ________________ 20
____________________________ __________________
SIGNATURE OF MEMBER DATE
Reviewed and approved by appropriate authority:
WARDEN (DESIGNEE) _____________________
