Policy Deviation Request

Policy Deviation Request

  1. Date

  2. People v.

  3. Please enter a valid phone number

  4. example@example.com

  5. Defense Attorney Address
  6. Pending Charges
  7. Count 1
  8. Count 2
  9. Count 3
  10. Count 4
  11. Count 5
  12. Specific deviation result requested (required)
  13. Count 1
  14. Count 2
  15. Count 3
  16. Count 4
  17. Count 5
  18. examples may include: anger management, evaluation/counseling, substance abuse evaluation, documentation as to AA NA attendance or other counseling, etc.

  19. Defendant's status on date of offense*
  20. Treatment Court, if attending
  21. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  22. Leave This Blank:

  23. This field is not part of the form submission.