DC3-2026 (Effective 2/14) Incorporated by Reference in Rule 33-302.110, F.A.C.
SPECIAL CONDITIONS OF SUPERVISION – List progress made this past month on special conditions ordered, including:
PUBLIC SERVICE HOURS: ______________________ MONETARY PAYMENT: ______________________ OTHER: ______________________
TREATMENT ATTENDED THIS PAST MONTH: ________________________________________________________________________________
NOTE: Attach required Support Group Attendance forms, driving logs, public service work documentation, etc. as required.
PAYMENTS: Payments may be made by either U. S. Mail or credit card using one of the services described on the DC Public Web site,
www.dc.state.fl.us under the Probation link “FAQS” - Frequently Asked Questions– Four Ways to Pay Court Ordered Payments.
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CONTACT WITH LAW ENFORCEMENT – If you had any contact with law enforcement this past month, explain details here: _________________
_____________________________________________________________________________________________________________________
Do you have a problem or concern you would like to discuss with your probation officer? YES NO
How did you spend your free time last month? _________________________________________________________________________________
________________________________________________________________________________________________________________________
PERSONAL GOALS: Write each of your top 2 goals you are working to achieve. Indicate at least 2 action steps you took last month and 2 action
steps you will take this month to achieve each goal.
GOAL # 1:
________________________________________________________________________________________________________________________
__________________________________________________
ACTION STEPS I TOOK LAST MONTH:
1. __________________________________________________________________________________
2. __________________________________________________________________________________
ACTION STEPS I WILL TAKE THIS MONTH:
1. __________________________________________________________________________________
2. __________________________________________________________________________________
GOAL # 2:
________________________________________________________________________________________________________________________
__________________________________________________
ACTION STEPS I TOOK LAST MONTH:
1. __________________________________________________________________________________
2. __________________________________________________________________________________
ACTION STEPS I WILL TAKE THIS MONTH:
1. __________________________________________________________________________________
2. __________________________________________________________________________________
________ _____________
Signature Date
Signature of Officer Receiving Report Date Report Reviewed
Officer Comments:
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