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Pre-Sentence Investigation Initial Check-In Form
Instructions:
This form must be answered by the defendant.
Answer all questions completely and to the best of your ability.
Please be honest and accurate.
After completing and sending this form, contact Justice Services at 208-799-3176 to confirm that the form was received and to schedule your PSI appointment.
PSI Intake Form
DNNSmart SuperForm Module
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Personal Information
Name - Last, Middle, First
Other Names Used
Gender:
Male
Female
Ethnicity:
Hispanic
Non-Hispanic
Race:
White
American Indian/Alaskan Native
Asian/Pacific Islander
Black
Other
If Race is Other, please list
Primary Language
Date of Birth
Place of Birth
Last Four Digits of Social Security No.
Driver's License No. or State Issued ID No.
State ID issued under
-- Select --
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Minor Outlying Islands
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
License or ID Expiration Date
Is License or ID Valid?
Yes
No
If License or ID is not valid, explain why.
Do you have a vehicle?
*
Yes
No
What is your transportation method?
Height
Weight
Hair Color
Eye Color
Scars, Marks, Tattoos
Cell Phone
Home Phone
Work Phone
Message Phone
Email Address
If you have a medical condition, please explain
If you are a registered sex offender, please explain
If you have anger or violence tendencies, please explain
If you have a history of mental illness, please explain
Living Arrangements
How many times have you moved in the past year?
What is your current physical address?
What is your current mailing address?
How long have you lived there?
Type of Housing
House
Apartment
Shelter
Other
If other housing, please list
Do you own, rent, lease or none of these?
Own
Rent
Lease
None of these
Person 1 living with you
Person 1 - Have they been to Court or on probation?
Yes to Court
No Court
Yes has been on probation
No Probation
Person 2 living with you
Person 2 - Have they been to Court or on probation?
Yes to Court
No Court
Yes has been on probation
No probation
Person 3 living with you
Person 3 - Have they been to Court or on probation?
Yes to Court
No Court
Yes has been on probation
No probation
Person 4 living with you
Person 4 - Have they been to Court or on probation?
Yes to Court
No Court
Yes has been on probation
No probation
Person 5 living with you
Person 5 - Have they been to Court or on probation?
Yes to Court
No Court
Yes has been on probation
No probation
Employment
Do you have a job?
*
Yes
No
If yes, where do you work?
Work Address
Date Started
Hourly Wage
Hours worked per week
Do you receive benefits?
Yes
No
Supervisor's Name and Phone Number
Have you ever been fired from a job?
Yes
No
Have you ever been unemployed for a full year?
Yes
No
Do you receive SSI Disability
*
Yes
No
If yes, list amount of SSI Disability received per month:
Do you receive Medicaid
*
Yes
No
If yes, list amount of Medicaid received per month:
Do you receive Food Stamps?
*
Yes
No
If yes, list the amount of Food Stamps received per month:
Do you receive Child Support?
*
Yes
No
If yes, list the amount of Child Support received per month:
Do you receive any Other Income?
Yes
No
If yes, list the amount of any Other Income received per month:
Military Background
Have you ever served in the United States Armed Forces?
*
Yes
No
Branch of Service served in
Type of Discharge
Year Enlisted:
Year Discharged:
Combat?
Yes
No
Do you receive benefits from the VA?
Yes
No
If you receive benefits from the VA, how much per month?
Family
What is your marital status?
*
Single
Married
Divorced
Separated
Significant Other
Widowed
How many children do you have?
How many of your children are minors?
How many of your children live with you?
CHILD 1 - Name (Last, First)
CHILD 1 - Date of Birth
CHILD 1 - Gender
Male
Female
CHILD 1 - Custody Status, Lives With
CHILD 1 - Do you pay Child Support?
Yes
No
CHILD 1 - If yes, Child Support Monthly Amount
CHILD 1 - If yes, are Child Support payments current?
Yes
No
CHILD 2 - Name (Last, First)
CHILD 2 - Date of Birth
CHILD 2 - Gender
Male
Female
CHILD 2 - Custody Status, Lives with
CHILD 2 - Do you pay Child Support?
Yes
No
CHILD 2 - If yes, Child Support Monthly Amount
CHILD 2 - If yes, are Child Support payments current?
Yes
No
CHILD 3 - Name (Last, First)
CHILD 3 - Date of Birth
CHILD 3 - Gender
Male
Female
CHILD 3 - Custody Status, Lives with
CHILD 3 - Do you pay child support?
Yes
No
CHILD 3 - If yes, Child Support Monthly Amount
CHILD 3 - If yes, are Child Support payments current?
Yes
No
CHILD 4 - Name (Last, First)
CHILD 4 - Date of Birth
CHILD 4 - Gender
Male
Female
CHILD 4 - Custody Status, Lives With
CHILD 4 - Do you pay Child Support?
Yes
No
CHILD 4 - If yes, Child Support Monthly Amount
CHILD 4 - Are Child Support payments current?
Yes
No
CHILD 5 - Name (Last, First)
CHILD 5 - Date of Birth
CHILD 5 - Gender
Male
Female
CHILD 5 - Custody Status, Lives With
CHILD 5 - Do you pay Child Support?
Yes
No
CHILD 5 - If yes, Child Support Monthly Amount
CHILD 5 - If yes, are Child Support payments current
Yes
No
CHILD 6 - Name (Last, First)
CHILD 6 - Date of Birth
CHILD 6 - Gender
Male
Female
CHILD 6 - Custody Status, Lives With
CHILD 6 - Do you pay Child Support?
Yes
No
CHILD 6 - If yes, Child Support Monthly Amount
CHILD 6 - If yes, are Child Support payments current?
Yes
No
EMERGENCY CONTACT 1 - Name (Last, First), relationship, phone no, address
EMERGENCY CONTACT 1 - Date of Birth
EMERGENCY CONTACT 1 - Gender
Male
Female
EMERGENCY CONTACT 1 - Have they been to Court or on probation?
Yes to Court
No Court
Yes has been on probation
No probation
EMERGENCY CONTACT 2 - Name (Last, First), relationship, phone no., address
EMERGENCY CONTACT 2 - Date of Birth
EMERGENCY CONTACT 2 - Gender
Male
Female
EMERGENCY CONTACT 2 - Have they been to Court or on probation?
Yes to Court
No Court
Yes has been on probation
No probation
EMERGENCY CONTACT 3 - Name (Last, First), relationship, phone no., address
EMERGENCY CONTACT 3 - Date of Birth
EMERGENCY CONTACT 3 - Gender
Male
Female
EMERGENCY CONTACT 3 - Have they been to Court or on probation?
Yest to Court
No Court
Yes has been on probation
No probation
EMERGENCY CONTACT 4 - Name (Last, First), relationship, phone no., address
EMERGENCY CONTACT 4 - Date of Birth
EMERGENCY CONTACT 4 - Gender
Male
Female
EMERGENCY CONTACT 4 - Have they been to Court or on probation?
Yes to Court
No Court
Yes has been on probation
No probation
Questions
What was your age at first arrest?
Under 16 years old
16-22 years old
23 or older
How many times have you been arrested (including juvenile arrests)?
0-3 times
4-9 times
10 or more times
Have you ever been incarcerated upon conviction?
Yes
No
Do you have a high school diploma, GED or other education certificate?
High School Diploma
GED
Other
If Other, please list
Highest Grade Completed
Have you ever been suspended (including in-school suspension) or expelled from school?
Yes
No
Have you ever received a probation violation or been charged with a new crime while on probation?
Yes
No
Do you own or possess any firearms or ammunition?
Yes
No
Do you own any animals that could be considered dangerous?
Yes
No
Does the current case you are being charged with directly or indirectly involve the use and/or possession of drugs and/or alcohol?
Yes
No
Have you ever been charged or arrested for an assaultive or violent crime?
Yes
No
Other than your current charge(s), do you have any other felony or misdemeanor charges in Idaho?
Yes
No
If yes, how many other felony or misdemeanor charges in Idaho?
Do you have any prior felony or misdemeanor charges in a different state?
Yes
No
If yes, how many prior felony or misdemeanor charges in a different state?
Do you have any pending cases in Idaho or a different state?
Yes
No
If yes, how many pending cases in Idaho or a different state?
Do you have any short term goals (3-6 months)?
Yes
No
If yes, list No. 1 short term goal:
If yes, list No. 2 short term goal:
Do you have any long term goals (1-2 years)?
Yes
No
If yes, list No. 1 long term goal
If yes, list No. 2 long term goal
Drug, Tobacco & Alcohol Use
PRIMARY Choice of Substance or Alcohol used, age first used, and how often do you use?
PRIMARY Choice - How do you administer?
Inject
Inhale
Oral
Smoke
PRIMARY Choice - Date last used, days used in the last 30 days, and who do you use with?
SECONDARY Choice of Substance or Alcohol used, age first used and how often do you use?
SECONDARY Choice - How do you administer?
Inject
Inhale
Oral
Smoke
SECONDARY Choice - Date last used, days used in the last 30 days, and who do you use with?
THIRD Choice of Substance or Alcohol used, age first used, and how often do you use?
THIRD Choice - How do you administer?
Inject
Inhale
Oral
Smoke
THIRD Choice - Date last used, days used in the last 30 days, and who do you use with?
Have you ever been in alcohol or drug treatment?
Yes
No
Have you ever been in mental health treatment?
Yes
No
THE RESPONSES GIVEN UNDER ALL THE STEPS ABOVE ARE TRUTHFUL TO THE BEST OF MY KNOWLEDGE
*
Yes
No
Submit
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