1. Reason for Revoke:

2. How many times have you been Revoked:

3. Type of Crime Conviction:

4. Sentenced Time:

5. Number of Years served before Paroled:

6. Was this your first, second, third, etc. conviction:

7. How long were you on Parole before being Revoke:

8. What were the hardest issues/problems with your parole: Circle: Housing, Work, Transportation, Hardship of time designated on reporting on parole, Take off from work to go report in, Time frame of having to take off from work for reporting, not able to contact Parole Office after hours, etc............ Other___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

9. Parole reporting where Parole Officers felt free to use verbal and emotional abusive and threatening language when it was uncalled for or just because they wanted to make you fearful of them enabling them to be more in control of your life: Please be honest about this issue if you did or did not provoke their actions. Which this is not allowed at any time but critical information for our Organization to Know about. Comments:___________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.

Please explain other issues and problems between you and your Parole Officer. Again honesty is of the most importance. Comments:______________________________________

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Confidential: It is not required but would appreciate the information should we need to re-contact you. This information will be kept confidential. Only the answers on above questions will be used.

Name:_____________________________________________

Age of Conviction:___________________________________

Age Now:__________________________________________

TDCJ ID #:_________________________________________

Date of this Information Furnished:_______

Address that can be contacted or mail forward to and/or significant other that can be contacted on your behalf:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

If our organization can answer questions or be of assistance to you and/or your love ones, please let us know.

The main purpose of PAPA is to bring AWARENESS of incarceration and parole to our Law Makers, the Representatives and Senators of our State of Texas.

PAPA would like to furnish a stamp envelope for the return of this information but due to the rulings we are not able to do that.

Thank you, People Against Prison Abuse, PAPA, P.O. Box 12446, Odessa, TX 79768-2446