TEXAS DWI INTERVENTION PROGRAM PERSONAL DATA FORM

INFORMATION CONCERNING THE ARREST THAT BROUGHT YOU HERE

As a participant in this program you must follow these agreements and program requirements:

• You must participate in group discussions, 1-to-1 sessions, and homework.
• You may express your opinions and feelings and are free to say whatever you feel as long as it doesn’t disrupt the class.
• You must bring a significant other (spouse, if married) to Modules 9 and 10, Family week.
• You must develop an action plan.
• You must be on time. If you are late (15 min.) or do not show up for class you may be dropped from this program or be required to attend additional group or individual sessions.
• There will be breaks during class. However, you must return on time.
• There will be no smoking or eating during class. Smoking during breaks will be permitted in designated areas.
• No visitors are allowed except during Family Week, Modules 9 and 10.
• You must abstain from the use of mood altering chemicals throughout this program.
• You will attend at least two A.A. meetings between Modules 11 and 12.
• In an emergency situation whereby an absence is unavoidable, you must call your instructor to schedule a make-up session. The make-up should be completed before the next class session. If you fail to make up a missed class session you will be dropped from the program. No more than two absences are allowed.

Please provide one answer, True or False for each question.
There is no right or wrong answers; just answer the way you feel.
Answer every question; blank responses are not permitted.