The California Alternative Custody form is a document that allows eligible inmates to participate in the Alternative Custody Program (ACP). This voluntary program promotes family reunification and personal development by permitting inmates to serve their time in a private residence or treatment facility instead of a traditional prison setting. If you are interested in learning more about the ACP and how to fill out the form, please click the button below.
The California Alternative Custody Program (ACP) offers a unique opportunity for eligible inmates to serve their time outside of traditional prison settings. This voluntary program emphasizes the importance of parenting, family reunification, and life skills development while addressing the specific treatment needs of participants. Under the ACP, inmates may reside in personal homes, transitional care facilities, or residential drug treatment programs, allowing them to maintain connections with their families and communities. However, eligibility for this program is contingent upon meeting certain criteria established by the California Department of Corrections and Rehabilitation (CDCR). The decision for placement ultimately lies with the CDCR, considering factors such as bed availability. While in the program, participants must adhere to the rules and regulations set forth in the California Code of Regulations, Title 15, Division 3. Importantly, inmates should be aware that they can be returned to prison at any time, with or without cause, to complete their original sentences. The application process involves several steps, including the completion of the ACP application and voluntary agreement form, where inmates indicate their willingness to participate and provide necessary information about their proposed living arrangements. This form serves as a critical component in facilitating the transition from incarceration to a more supportive environment, fostering rehabilitation and reintegration into society.
STATE OF CALIFORNIA
DEPARTMENT OF CORRECTIONS AND REHABILITATION
ACP APPLICATION AND VOLUNTARY AGREEMENT
CDCR 2234 (07/12)
The Alternative Custody Program (ACP) is a voluntary program that promotes parenting, family reunification and the development of life skills while addressing treatment needs. The ACP allows inmates to be housed in a personal residence, a transitional care facility or a residential drug or treatment program instead of serving time in prison. I understand placement into the ACP is based upon meeting specific eligibility criteria and the California Department of Corrections and Rehabilitation has the authority for final placement approval based on bed availability and other factors. While participating in the ACP, I will be subject to applicable rules and regulations governing inmates pursuant to the California Code of Regulations (CCR), Title 15, Division 3. I understand I may be removed from the ACP and returned to prison to serve the remainder of my original sentence for any reason, with or without cause.
I. TO BE COMPLETED BY INMATE
I meet the criteria set forth in the CCR Title 15, section 3078.2 including the following: (Check all that apply)
I am a female
(Select one)
I have private medical insurance. OR
I agree to apply for any county, state or federal medical coverage for which I may qualify.
I request to reside at the following location:
Private Residence
My private residence is located at:
(Include street address, city, county and zip code)
(I understand my residence must have no aggressive animals, no weapons, unobstructed access by law enforcement and will be verified by a Parole Agent.)
The contact person at the above address is:
My relationship to the contact person is:
The contact person’s telephone number is:
Residential Drug or Treatment Program or Transitional Care Facility
I understand that my signature on this document indicates my willingness to voluntarily participate in the ACP.
CDC NUMBER
INMATE NAME (PRINTED)
INMATE SIGNATURE
DATE SIGNED
HOUSING UNIT
II. FOR USE BY INSTITUTION COUNSELING STAFF
Does the participant have a qualifying disability requiring effective communication?
Yes
No
If yes, cite the source document and/or observation(s):
___________________________________________________________________
What type of accommodation/assistance was provided to achieve effective communication to the best of the inmate’s ability?
COUNTY OF LAST LEGAL RESIDENCE
COUNTY OF COMMITMENT
INSTITUTION
EPRD
INMATE
REASON, IF INELIGIBLE
ELIGIBLE
INELIGIBLE
CORRECTIONAL COUNSELOR NAME (PRINT)
CORRECTIONAL COUNSELOR SIGNATURE
PHONE NUMBER
III. FOR USE BY ACP PROGRAM MANAGER
ACP PROGRAM NAME
ACP PROGRAM ADDRESS
ASSIGNED PAROLE UNIT
IV. FOR USE BY PAROLE UNIT
DISTRICT/UNIT
RECEIVING AGENT ASSIGNED TO INVESTIGATE
COMMENTS:
DATE ASSIGNED
DATE DUE
AGENT’S RECOMMENDATION
Proposed residence meets criteria
PAROLE AGENT NAME (PRINT)
PAROLE AGENT SIGNATURE
UNIT SUPERVISOR APPROVAL
Concur with agent’s recommendation
UNIT SUPERVISOR NAME (PRINT)
UNIT SUPERVISOR SIGNATURE
UPON COMPLETION OF PRIVATE RESIDENCE VERIFICATION - RETURN THIS FORM TO THE SENDING INSTITUTION C&PR OFFICE
*EPRD means Earliest Possible Release Date
Distribution: Original to c-file; copy to inmate
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