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E-mail Address:
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Screening Items:

Name of the agency:
Type of agency:
Criminal Justice/Corrections Agency
Treatment Provider
Non-profit Government Agency
Non-profit Community Agency
Case Management Provider
Consulting/Technical Assistance/Training Provider
Specialty Court (e.g., drug court, mental health court)
Other (please specify)
Does anyone else from your agency currently have an RNR Simulation Tool account?:
Don't Know
How did you hear about the RNR Simulation Tool?
Attended a training session on the tool
Attended a presentation on the tool
Was referred by another agency/individual
    Please specify agency/individual:
CSAT request for proposals (RFP)
Internet search
Other (please specify)
Which portal(s) of the tool do you plan to use? (Check all that apply)
Assess an Individual
RNR Program Tool for Adults
Assess Jurisdiction's Capacity
How do you plan to use the tools?
Your Name:
Your Position:
Your Email:
Your Phone:
Please estimate how many Basic user accounts your agency/jurisdiction will need:
Please estimate the number of clients you will enter into the Assess an Individual portal:
Please estimate the number of programs to be classified using the RNR Program Tool for Adults:
Please estimate how long (in months) your agency will use the RNR Simulation Tool service:
Please estimate how long (in months) you would like the information you enter into the tool to be saved/accessible:
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