CORRECTIONAL FACILITY
                                                                FACTS SHEET

DATE: ________

LOCATION:_____________________________________

NAME OF FACILITY:_____________________________________

TYPE OF FACILITY:______________________________________

POPULATION: MALE__________ FEMALE___________

BLACK ______HISPANIC______ WHITE_________ YOUTH________ 

AVERAGE LENGTH OF STAY

ESTIMATED POPULATION WITH A DRINKING PROBLEM____________

ANY POPULATION THAT SHOULD BE EXCLUDED FROM MEETINGS

MEETING SPACE AVAILABLE WITHIN THE FACILITY AND 
LOCATION___________________________________________________________________
        

SCHEDULE OPTIONS:____________________________________________________________________

______________________________________________________________________________

CRITERIA FOR CFC REPRESENTATIVES TO ENTER THE FACILITY 
______________________________________________________________________________
______________________________________________________________________________

NUMBER OF VOLUNTEERS PER MEETING:________________

PROCEDURES FOR ENTERING THE FACILITY:____________________________________

SPECIAL RESTRICTIONS (I.E. KEYS, WALLETS, PURSES, ETC.) _____________________
________________________________________________________________________________

CFC CONTACT FOR WOMEN (NAME AND PHONE #)_______________________________
________________________________________________________________________________
                                                                                         
                                                                                       
INSTITUTIONS CONTACT FOR WOMEN (NAME AND PHONE #)_____________________
________________________________________________________________________________

CFC CONTACT FOR MEN (NAME AND PHONE #)__________________________________
________________________________________________________________________________

INSTITUTIONS CONTACT FOR MEN (NAME AND PHONE #)________________________
________________________________________________________________________________

MATERIALS AND SUPPLIES THAT MAY BE USED AT THE MEETINGS:______________
________________________________________________________________________________

RESTRICTIONS:________________________________________________________________

________________________________________________________________________________

SPECIAL CONSIDERATIONS:_____________________________________________________
_________________________________________________________________________________

COMMENTS:____________________________________________________________________

PROGRAM PLAN OR FOLLOW UP WILL BE SUBMITTED BY_______________________
NO LATER THAN_______________________________________________________________
_______________________________________________________________________________