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2. Community Corrections Referral Application

   
   

   Please include as much information as possible.  

   Applications will be considered for all Community Corrections Diversion Programs.  Community Corrections staff will make a recommendation to the County Attorney's Office for final approval.  

   *Drug Court Judges will make the final decision regarding eligibility for the Drug Court Program.

4. DUI Court Referral's
   DUI Court
5. Veteran's Court Referrals
   Veteran's Court
7. Applicant Information
9. Please check the programs you believe are most appropriate for consideration.

   1. General Diversion
   2. Intensive Supervised Diversion (ISD)
   3. Treatment Diversion
   4. Mental Health Diversion
   5. Veteran's Diversion
   6. Adult Drug Court
11. Name*
12. DOB
    DOB
13. Currently Incarcerated

    1. Yes
    2. No
15. Phone Number
16. Email Address
18. Address
20. City
21. State
22. Zip Code
24. Primary Language
25. Is the applicant a veteran?
    -- Select One --NoYesUnknown
27. Other Pending Cases/Warrants
29. Case/Attorney Information
31. Docket/Case Numbers
33. Charges in Each Case
35. Filing Date (Oldest Case)
    Filing Date (Oldest Case)
37. Defense Attorney
39. Defense Attorney Address
40. City
41. Zip Code
43. Attorney Email Address
44. Attorney Phone Number
46. Comments:
48. Upload any attachments
49. Upload Any Attachments
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit

* indicates a required field