State of Vermont,
Agency of Human
Services
Department of
Corrections
Chapter:

Programs – Volunteer
Services

Page 1 of 13
Title: Religious

Observance

# 380.01

Supersedes #380, dated
9/27/1984

Attachments, Forms & Companion Documents:
1. Inmate Religious Preference Registration Form
2. Request for Change of Faith Group Affiliation
3. Religious Personal Property Matrix
4. Inmate Religious Accommodation Request Form
Local Procedure(s) Required: Yes (See p. 3, Section 2. d.)
Applicability: All facility staff (including volunteers and contractors)
Security Level: “B” – Anyone may have access to this document.

Posted for Comment July 16 – August 6, 2007
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PURPOSE
The purpose of this directive is to establish the Department of Corrections’ policy and procedures
regarding inmate religious practices and programming.
POLICY
It is the policy of the Vermont Department of Corrections to make available to inmates an
opportunity to participate in religious services and programs and to exercise their religious beliefs
within the inherent need for facility safety and security. Faith-based programs and observances will
be accommodated within available time and space, unless an overriding compelling governmental
interest exists.
AUTHORITY
28 V.S.A 803, § 11 (a)(b); American Correctional Association Standards for Adult Correctional
Institutions, 4th Edition 2003, Standards 4-4517, 4-4518, 4-4520, 4-4273, and 4-4319.
REFERENCE
Department Administrative Directives #354.05 Inmate Alternative Diets; #376.01 Volunteer
Services Management; #409.01 Contraband & Searches; #327.01 Inmate Visits
DEFINITIONS
Compelling Governmental Interest: Overriding concerns of the Department of Corrections that must
be maintained, using the least restrictive means, regardless of other issues or requests. These
include, but are not limited to, safety, security, consistency, health, and discipline.
Donation: Approved contributions to inmate programs.
Donor: An approved group or individual authorized to donate approved program items or resources
for inmate religious or recreational programs.

#380.01 Religious Programs
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Page 2 of 13

Faith Representative: Refers to a spiritual leader who is empowered by a particular faith group to
administer ordinances and sacraments, perform rites, counsel, instruct, and provide worship and
religious services.
Faith Group: A religious or spiritual denomination, sect, or organization that is recognized by the
Department of Corrections.
Proselytizing: Approaching someone with the intent to persuade that person to convert to a
particular faith group.
Registered Volunteer: Any person who performs a function within a correctional facility for no
payment from the Agency of Human Services. They may receive a stipend from an outside source.
They have completed a Department application, screening, and training, have a photo volunteer ID
and are listed with the Volunteer Services Coordinator as an approved volunteer.
Religious Activity: Any rite, ceremony, event, or program that is customarily associated with the
practices of a religion, including, but not limited to, formal group gatherings of adherents of a
religion for purposes of worship, prayer, or teaching.
Religious Advisor: An individual from the outside community who has received endorsement from
a faith group to provide individual religious counseling and guidance to an inmate.
Religious Observance Program: Includes any formal faith-based activities, services, and practices in
a correctional facility which are managed by staff in order for inmates to practice their religious
beliefs while incarcerated.
Religious Volunteer: A Department of Corrections’ approved volunteer who assists and/or conducts
individual or group religious activity in a correctional facility.
Religious Volunteer Chaplain: An approved member of the clergy, Imam, Rabbi, spiritual advisor
or other religious authority of sufficient rank qualified to direct, lead or conduct others in the rites,
ceremonies or other practices of a religion who is approved by the Department of Corrections as a
volunteer.
Security Threat Group (STG): A group of inmates specifically designated by the Commissioner or
designee which poses a threat to the safety of staff, the facility, the public or other inmates.
Volunteer Services Coordinator (VSC): The correctional staff person who has responsibility for the
volunteer services program in a correctional facility, including the religious observance program.
This position is also responsible for overall program development for recreation and leisure
programs.
PROCEDURAL GUIDELINES
The Department of Corrections will provide guidelines that offer inmates the opportunity to
participate in religious programming and the practices of their faith, individually or in a group,
limited only by resources, threats to safety, or order in the facility. The religious programs offered
will reflect the diversity of faith and traditions in the larger outside community to the extent
possible.

#380.01 Religious Programs
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Page 3 of 13

1.

Management Responsibility
a. Statewide responsibility for the management of the religious observance program will be
under the direction of the Department of Corrections’ Facility Executive in conjunction
with the central manager assigned to oversee statewide volunteer services.
b. Facility responsibility for the coordination and management of the facility-based
religious observance program will be the Facility Volunteer Services Coordinator
(VSC).

2.

Inmate Access to Religious Programs and Services
a. Religious Preference
i. At the time of their admission to the Department of Corrections an inmate may
designate any or no religious preference on the Inmate Religious Preference
Registration Form, (Attachment 1).
ii. By notifying the facility Volunteer Services Coordinator, an inmate may request
to change their designation by completing a new Inmate Religious Preference
Registration Form. Any change will be effective ten (10) days following
submission of a request.
b. Access
i. To maintain security and order, and to prevent abuse or disrespect of the
religious beliefs of others, an inmate may participate in a religious program or
service only if:
• they have completed a Religious Preference Registration Form; or
• they have the written permission of the Volunteer Services Coordinator
to be an observer at a particular religious program or service.
ii. No inmate will be required or expected to attend any religious program or service
or to adhere to any religious belief.
c. Restriction of Religious Activities or Practices
i. Inmates will not be discriminated against because of religious beliefs and
practices.
ii. There will be no unreasonable burden placed on an inmate’s right to practice
their religion.
iii. If a restriction of a religious practice has been placed, staff will lift the restriction
after consultation with the Facility Executive, if corrective action has been taken
and there is no longer a perceived threat.
iv. Whenever an inmate requests a religious practice that has not been previously
approved at that facility, the facility Superintendent will consult with the
Department’s Facility Executive prior to making a decision.
v. Whenever an inmate’s exercise of a religious practice is denied, the facility will
prepare, in writing, the specific reasons supporting the denial, with a copy to the
Department’s Facility Executive and the inmate.
d. Religious Space – all recognized inmate religious groups will have equal access to the
physical space, equipment, and services which the institution normally provides for
religious purposes.
i. The Superintendent will ensure a designated area is made available for
conducting worship services, religious education, and activities. Assignment and
availability of the designated area will be at a reasonable time, place, and manner
and in conjunction with other facility activities, events, and needs.

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#380.01 Religious Programs
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Page 4 of 13
ii. Religious program space will be kept free of religious objects or symbols which
cannot be removed or covered between services by the different faith groups
using them. The Superintendent will ensure that local written procedures for the
use and storage of religious objects and symbols are developed.
e. Coordination and Management
i. The Volunteer Services Coordinator will schedule all religious programs and
activities. Scheduling will be coordinated among the various religions, other
facility operations or activities, and within the security needs and constraints of
the facility.
ii. ii. Facility staff will have access to all religious services and programs to ensure
the security requirements of the facility are being met.
3.

Range of Religious Activities and Services – Each facility will make reasonable efforts to
establish and maintain religious activities and services for all inmates.
a. Clergy Services – The Superintendents or designee will make reasonable efforts to
ensure that an accredited representative of an inmate’s religious faith is available to
provide formal or informal services to inmates who request them.
b. Religious Groups – Recognized groups or denominations will include, but not
necessarily be limited to, Catholic, Protestant, Jewish, and Muslim. An inmate who is
affiliated with, and wishes to participate in, a recognized religious group not currently
functioning at a facility should inform the facility Volunteer Services Coordinator. The
Volunteer Services Coordinator, in consultation with the facility Superintendent and
following the procedures of this directive, will make reasonable efforts to arrange for the
requested services.
c. Religious Activities – Each religious group is encouraged to plan its own activities,
using appropriate community and facility resources. Religious activities include, but are
not necessarily limited to, worship services, religious instruction, reading and study,
religious discussion groups, and pastoral counseling.
d. Religious Diets – Refer to Administrative Directive #354.05 Inmate Alternative Diets:
Medical, Dental and Religious for information on requesting a religious diet. Do not use
Attachment 4 in this directive to request a religious diet.
e. Religious Rights and Observances
i. An inmate may request a religious accommodation by filling out an Inmate
Religious Accommodation Request Form (Attachment 4) and submitting it to the
Coordinator of Volunteer Services. The Superintendent will approve or deny the
request.
ii. An inmate’s faith practice that requires accommodations by the Department must
be supported and verified by the faith’s recognized sacred text, historical
established procedures, and outside religious authorities. The Department will
make every effort to accommodate these religious observances unless there is a
facility or Department interest that necessitates restricting the observances.
iii. If an inmate has requested a specific religious accommodation (Attachment 4)
that was denied by the Superintendent, that decision will be reviewed by the
Department’s Facility Executive in consultation with the Department’s Legal
Division.

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#380.01 Religious Programs
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iv. Individual demonstrative prayer by inmates will only be allowed in the privacy
of their living cell/room and in designated religious areas as determined by the
schedule of religious activities. However, an inmate, while in the outside
recreation yard, may choose to engage in non-group demonstrative prayer that
does not interfere with recreational activities.
v.
Group prayer may only occur in a designated religious area during a religious
service at times authorized by the Facility Superintendent.
vi. Inmate possession of security threat group materials or symbols is prohibited.
First Amendment free exercise of religion protection applies to religious ideas
and symbols by faith groups whose only purpose is religious; it does not extend
to security threat group use of religious ideas and symbols as a means of
organizing and meeting.
vii. Inmates will not be allowed to act in a position of spiritual leadership,
supervision, or authority over other inmates.
viii. Inmates possessing faith-based credentials or titles obtained prior to or during
incarceration in the Department of Corrections will have such credential/titles
deemed inactive during their term of incarceration.
ix. When a faith group representative or religious volunteer is not present to
facilitate a religious program, service, or observance, that faith group will not be
allowed to meet as a group until appropriate faith group supervision is available.
x.
The Superintendent retains the right to limit participation in religious programs.
This would occur upon documentation that an individual has shown a threat to
the safety of staff, inmates, or other persons involved in the religious activity, or
if that individual’s conduct disrupts the security or order in the facility based
upon facility needs, or documentation of a compelling governmental interest.
f. Work and Program Restrictions Due to Religious Beliefs
Each inmate will have certain days of the week in which work is not required.
Religious activities will normally be scheduled during what is regarded as “nonworking” hours for inmates, usually weekends, and after 4:00 p.m., Monday through
Friday. Inmates will not be excused from normal work or program responsibilities to
attend religious services or activities except under the following conditions:
i. When it is mandated by their faith that they abstain from work on a certain day or
must participate in a religious service at a specific time which conflicts with their
normal work or program schedule; (The facility Volunteer Services Coordinator
will maintain a list of religious observances which require such accommodations.
That list will be made available to all staff and volunteers.]
ii. When it is in the best interest of the facility to hold a religious service or activity
during normal work or program hours.
Inmates excused from a work or program assignment for reasons of attending a
religious service may be required to make up the missed time.
g. Religious Holy Days
The Department’s Facility Executive will notify Department Executives and Facility
Superintendents of the dates observed by the various religious faiths as religious holy
days or religious days of celebration. Guidance will be provided to facilities
regarding the sacramental or ritual needs of individual religions for each holy day or
religious day of celebration, including special preparations needed, food, and times
of day, or any restrictions on work, program, or other considerations.

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#380.01 Religious Programs
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i. Calendar – Prior to the end of October of each year, the Facilities Executive or
designee will issue a religious holiday calendar for the new year. The calendar
will list by faith group all known holy days of observance.
a) Native American religious ceremonies are not celebrated on specific
liturgical dates, but instead are celebrated as the cycle of nature
dictates. The actual date for each ceremony will be selected after
consultation with representatives of Native American groups.
ii. Three (3) business days prior to an approved holy day, the Volunteer Services
Coordinator will post copies of a Religious Program sign up sheet in each general
population housing unit. Only inmates affiliated with that specific faith group
will be allowed to participate in the respective holy day observance or program
activities.
iii. The Volunteer Services Coordinator will approve all program participants.
iv. Inmates newly arrived at a facility who are currently affiliated with the faith
group will be eligible to sign up, subject to review by the Volunteer Services
Coordinator.
v.
Food items purchased or provided from outside sources for holy day observances
will be allowed if one (1) of the following applies:
a) An approved volunteer provides food items and is present to conduct the
observance;
b) Where security permits, inmates may be allowed to purchase and bring
commissary food items to holy day observances when requested in
advance of the observance.
• Donated food items may not be designated for a particular inmate,
but will be available for the entire faith group.
h. Ceremonial, Holy Day Meals – Refer to Administrative Directive #354.05, Inmate
Alternative Diets: Medical, Dental and Religious, Section #3, Religious Diets.
4.

Supervision of Inmate Religious Programs and Services – All formal group religious
activities and programs will be conducted and supervised by Department-approved religious
volunteer chaplains or religious volunteers.
a. Religious Volunteer Chaplain – Upon clearance and approval as a Department of
Corrections’ volunteer, an individual possessing the necessary religions qualifications
and ranking of a particular religion may be designated as a volunteer chaplain.
i. A qualified individual may be designated as a volunteer chaplain with the
recommendation of the Facility Volunteer Services Coordinator and approval of
the Superintendent.
ii. The primary criterion in selecting a chaplain will be the ability to meet the
spiritual needs of inmates who adhere to a religion’s cultural beliefs. Indicators
of that ability include formal training, pastoral experience, and the ability to
converse with, encourage, and guide people who have spiritual and counseling
needs.
b. Religious Volunteers – As an approved Department of Corrections’ volunteer, a
religious volunteer may:
i. Assist a volunteer chaplain;
ii. Deliver religious services and programs for which they are qualified or have
authorization to do, including:
• leading study groups,

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#380.01 Religious Programs
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• supervising collective prayer,
• administering the spiritual rites of a religion,
• providing pastoral counseling.

Page 7 of 13

c. Religious Advisors – A religious advisor as defined by this directive need not be an
approved Department of Corrections’ volunteer. They must, however
i. be cleared to enter a correctional facility;
ii. have an endorsement or approval from a faith group;
iii. be approved by the Department.
5.

Religious Materials
a. Faith Group Property
i. The Department will permit faith group property, ritual supplies, and other
articles as necessary to conduct group religious services. All articles are subject
to being searched. During the conduct of religious services, chaplains, faith
representatives, and outside clergy may wear their religious vestments and/or
insignia.
ii. Facilities with appropriate space may designate a secure location for the storage
of faith group-related program materials. Where storage exists, there will be an
inventory list of all stored items approved by the Superintendent/designee located
in the storage area/cabinet.
iii. Items not on the approved inventory list will be considered contraband.
iv. Faith-specific reading materials, videos, and books may be stored with faith
group items. No personal inmate items may be stored with faith group property.
b. Inmate Religious Property Items
i. Only items listed on the Religious Personal Property Matrix (Attachment 3) may
be possessed by an inmate. All such items are subject to considerations of safety
and security. Once approved, all religious property authorized for an inmate
becomes part of an inmate’s personal property with any limitations set by
Department administrative directive.
a) Inmates may receive and retain possession of personal religious
items/symbols essential to their designated religious preference.
b) All personal religious items, except those items approved at the time of an
inmate’s admission, will be purchased either from Canteen stock or
through an approved catalog source.
ii. Items not listed on the Religious Personal Property Matrix may be requested by
inmates by completing an Inmate Religious Accommodation Request Form
(Attachment 4). The request will be reviewed by the Superintendent, who will
forward the request to the Facilities Executive for approval or denial
c. Religious Medallions and Symbols
i. Approved religious medallions and symbols pertaining to an inmate’s designated
faith may be worn about the neck on a jewelry-type chain. Each inmate will be
permitted only one (1) religious medallion. Chain lengths, medallions, and
symbols may not exceed the sizes specified in the Religious Personal Property
Matrix or as noted below.
ii. All medallions must be listed on the inmate’s personal property inventory.
iii. Medallions that are designed with a pin to be worn on clothing are not permitted.
iv. Medallions may be made of metal, wood, or plastic and may be round in shape or
in the shape of the appropriate religious symbol such as a cross, star, or crescent.

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#380.01 Religious Programs
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v. Medallions not allowed include: swastika, iron cross, inverted cross, or any item
identified as gang-related or security threat group-related. Medallions may be no
longer than 1.5 inches in length or 1 inch in diameter.
vi. Medicine Bag - An inmate designated as Native American will be permitted one
(1) medicine bag as their medallion.
a) A medicine bag may not exceed a maximum length of 2.5 inches. It must
be made of leather, may not be embellished after purchase, and must be
suspended from a leather strap no longer than 24 inches.
b) A medicine bag may not be worn to the visiting room or while working in
food service.
c) All contents of a medicine bag must be approved as listed in this directive
and other forthcoming memos or attachments; e.g., calendar of holy days.
d) If staff choose to search the contents of the medicine bag, the contents
will be placed on a piece of paper and visually inspected. If a particular
item is called into question, staff will remove the item and place it in an
evidence bag for examination by the facility Security and Operations
Supervisor and a Native American Religious Advisor to determine its
appropriateness for inclusion.
d. Religious Articles
i. Prayer rugs – Inmates of faiths that use prayer rugs are permitted to possess only
one (1) prayer rug. It will be commercially-made and no larger than 30 inches by
40 inches. The rug may not be solid red, blue, or any camouflage colors.
ii. Religious head coverings
a) Inmates are permitted to wear religious head coverings in accordance
with their religious beliefs and as permissible as their security level
permits.
b) Inmates will be permitted to wear religious headgear in all areas of
the facility except the visiting room.
c) Staff may require an inmate to remove and search religious headgear at
any time for security reasons.
d) A faith group’s religious chaplain or religious advisor will be consulted if
there is any question whether the inmate’s practice and the head covering
itself are legitimate.
e) Examples of approved religious head coverings are:
• Kufi – a hemispheric head cap that can be made of cloth, knitted
or crocheted, multicolored or single colored. There are no color
prohibitions. The kufi may have a peak on top. It must fit close
to the head (hair). A kufi will have no protrusions (visor, tassels,
etc.).
• Yarmulke – a close-fitting skull cap that can be made of cloth,
knitted or crocheted, multicolored or single colored. There are no
color prohibitions.
• Tsalot-Kob – approved religious headwear for members of the
Rastafarian religious faith. A Taslot-Kob is a hemispheric head
cap that can be made of cloth, knitted or crocheted, multicolored
or single colored. Only the smallest size is permitted. It measures
12 inches long at its longest point in order to cover all locks. It
must fit as close to the head as the locks permit. Note: This
religious headwear is only authorized for members of the
Rastafarian faith.

#380.01 Religious Programs
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• Fez – a brimless, cone-shaped, flat-crowned hat that usually has a
tassel and usually is made of red felt.
• Khimar – an approved cloth headcovering (not to cover the face)
for female members of the Islamic faith measuring four feet (4’)
by four feet (4’). It may be multicolored or single colored.
iii. Religious Beads – Generally, rosary, Malta or dhikr beads may be possessed in
one’s hands, but not worn or displayed. Only black, white, or natural wood tone
beads will be allowed.
a) An inmate may request a permit to possess and wear other religious
beads, (excluding rosary, mala and dhikr beads) which can be
documented and supported on a theological basis for use in the practice of
an inmate’s documented religion.
b) The request should be in writing to the Superintendent/designee and
forwarded to the Department Facility Executive for approval or denial.
iv. Incense and Oils – Incense and oils are permitted only during faith formal group
services. No inmate may be in personal possession of incense or oils.
v. Candles and Incense – Candles and incense may be used in formal group worship
only, as approved by a religious advisor with the permission of the
Superintendent. No candles or incense are allowed in an inmate’s cell/room or
housing unit.

e. Religious Publications and Texts
Inmates may subscribe to and possess any religious publication approved through the
provisions established in the administrative directives governing inmate mail and
publications, inmate property, security threat groups, and contraband and searches.
Texts such as the Holy Bible, The Torah, Talmud, Midrash, and the Holy Koran will
normally be approved once they are searched.
f. Inmates in Restrictive Housing
i. Approved religious volunteers and chaplains may visit restrictive housing units
with prior approval of the Superintendent.
ii. Inmates in restrictive housing status may have a book of faith or other religious
publications according to the allowable limits of their restrictive status (see
Administrative Directive #410.06, Restrictive Housing Status).
iii. Allowable inmate religious property may be limited on an individual basis if it is
proven to be a security risk or provides an inmate with the means to injure
themselves.
TRAINING
The Director of Security Operations and Audits will work with the Director of Human
Resources Development to provide training on the provisions of this administrative
directive.
QUALITY ASSURANCE
The Director of Security Operations and Audits in conjunction with the Director of Quality
Management will, through the use of established auditing procedures and the
offender/inmate grievance system, monitor compliance with this directive.

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#380.01 Religious Programs
ATTACHMENT 1 - SAMPLE

Posted for Comment 7/16 -8/06/07

INMATE RELIGIOUS PREFERENCE REGISTRATION FORM
Check one (1) faith group or, where offered, the one sect or denomination that you intend to
practice while incarcerated. If you do not intend to practice a religion, check None. If you would
like assistance in completing the form, submit a request to a staff person.
You may participate in only one (1) formal group religious program – the one that you select on this
form.
You may change a selection of None to a specific group at any time. It will take effect ten (10) days
after submitting the request. You may change from one group to another once (1 x) during a
calendar year.
_____ This is an original request.

_____ This is a change of religious preference.

Buddhism
Roman Catholic
Islam
Nation of Islam, Lost-Found
Nation of Islam, Farrakhan
Sunni
Shi’s
Other
Hinduism
Jehovah Witness
Judaism
Native American
Church of Jesus Christ Christian
Church of Jesus Christ of Latter Day Saints
(Mormons)
Sacred Name Groups
Assemblies of Yahweh
House of Yahweh
Non-pagan or Earth-based Traditions
Odinism, Asatru & Other Norse
Germanic Pagan Traditions
Wicca
Other
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Rastafari
Orthodox
Eastern
Greek
Russian
Other
Protestant
African Methodist Episcopal/Zion
Apostolic
Assembly of God
Baptist
Episcopalian
Evangelical
Lutheran
Methodist
Pentecostal
Presbyterian
Quaker
Seventh-day Adventist
United Church of Christ
Other
NONE

Inmate Name:________________________________________DOB:_______________________
Inmate Signature:_____________________________________Date:________________________
Staff Witness:________________________________________Date:________________________
Facility:_____________________________________________
Cc: Volunteer Services Coordinator, Inmate, Inmate Core File

#380.01 Religious Programs
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Posted for Comment 7/16 -8/06/07

Page 11 of 13

ATTACHMENT 2 - SAMPLE
VERMONT DEPARTMENT OF CORRECTIONS

REQUEST FOR CHANGE OF FAITH GROUP AFFILIATION
(Print clearly; unreadable requests will not be processed.)
DATE:_______________________________FACILITY:________________________________
INMATE NAME:________________________________________DOB:________________
CASEWORKER:_______________________________________________________________
CHANGE FAITH GROUP AFFILIATION TO:________________FROM:________________
Note: You may not make another faith group affiliation change for 12 months from the approved
date.
Inmate Signature:__________________________________________________________________
_________________________________
Volunteer Services Coordinator/designee

_______________________ ______________
Date Received
Date Forwarded

_________________________________
Faith Group Representative Coordinator/
Designee

__________________________ Approved or Denied
Date
(Circle one)

REASON FOR DENIAL:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
ELIGIBLE FOR FAITH GROUP AFFILIATION CHANGE
ON:___________________________
(Date)

Cc: Facility Volunteer Services Coordinator, Property Officer, Caseworker, Religious Advisor,
Inmate, Inmate Core File

#380.01 Religious Programs
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Posted for Comment 7/16 -8/06/07

Page 12 of 13

ATTACHMENT 3 - SAMPLE

RELIGIOUS PERSONAL PROPERTY MATRIX
Personal faith group property is not faith-specific.
It is limited to that which fits within designated containment space for personal property.
General

Medallion Chain (may possess only one,
which must be in conjunction with a
medallion)

____Calendar (1)
____Deity pictures (up to 6)
____Deity statue (up to 6”) (1)
____Prayer Rug (1)*
____Prayer Wheel [or picture] (1)

____18”
____20”
____24”

Head Coverings (may possess only one)*
____Head band [male]
____Head covering [female]
____Hijab [female]
____Kufi [male]
____Prayer scarf [female]
____Skull cap (yarmulke) [male]
____Turban [male]

Medallion (may possess only one)
____Allah (metal)
____Ankh (metal)
____Cross (metal)
____Crucifix (metal)
____Pentagram (metal)
____Star of David (metal)
____Thor’s Hammer (metal)
____Medicine Bag w/strap (leather)

Cards *
____Oracle (1)
____Rune (1)
____Sacred Path w/book (1)
____Tarot (1)
____Thoth Tarot (1)

Beads (one (1) strand only)
____Japamala
____Kunti Mala
____Prayer beads
____Standard Rosary
Prayer bead color: black, white or natural
wood tone

Herbs (Native American only)
____Sage
____Sweetgrass
____Cedar

Feathers (Native American only)
____Hawk
____Bald Eagle
____Golden Eagle

*Administrative Segregation Units may have starred items only.
Inmate Name:__________________________________DOB:_____________Date:___________
Property Officer Signature:________________________________________________________
Facility:_______________________________________Date:_____________________________

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#380.01 Religious Programs
ATTACHMENT 4 - SAMPLE

Posted for Comment 7/16 -8/06/07

Page 13 of 13

INMATE RELIGIOUS ACCOMMODATION REQUEST FORM
If more than one inmate is filing a request, each inmate must submit a form. If this is a group
request, information must be submitted to the facility Volunteer Services Coordinator who will
compile information about the group request and forward the information to the Department of
Corrections Facility Executive and the facility Superintendent. NOTE: Do not use this form to
request a religious diet. See administrative directive #354.05, Inmate Alternate Diets, for the
correct form.
Inmate Name:
DOB:
Date:
Name of Religion:
1. Describe, in detail, your religion’s basic tenets or beliefs which you feel require that you be
provided with the requested accommodation:

2. Give a detailed description of the requested accommodation:

3. List any publications which explain the religious significance of the requested accommodation.
Provide a copy of the publication(s) to the Volunteer Services Coordinator.

4. Is there a recognized governing body for this Faith Group? If so, please provide contact
information.
Inmate Signature:
VSC Signature:
Superintendent Signature:

Date:
Date:

□

□

Comments and/or Recommendation:
Approved
Denied (& Reason – Use back if
needed.)
Facility Executive Signature:
Date:
Comments and/or Recommendation: Use back if needed.
577

Cc: Volunteer Services Coordinator, Inmate, Inmate Core File