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LOTUS CENTRE – EHSP

TALIPOT UNIT No. 8


RESIDENTIAL AND REHABILITATION PROGRAMME
FEEDBACK FORM

Date: ..........................................

Nom client: ......................................................................

Numero: ……………….

L’age: …………..

L’addresse: …………………………………………………………………………….....................................................

L’education: ……………………………

Offence: ………………………………………………………….

Date discharge: ………………………………….

Ene ti Feedback: ………………………………………………………………………………………………………...

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Motivation pou suive program dan centre Lotus: …………………………………………………………………….

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 Mo porte mwa volontaire pou suive ban program dan centre Lotus: …………..

 Mo accepter donne ene koudme ek recevoir ene koudme dan centre Lotus: ……………..

 Mo admet pou suive discipline dan centre Lotus: …………………….

Signature pou deteni: …………………………….. Initial pou Officier: ……………………………

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