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Pre Trial Drug Education Program Application Order Disposition JD-CR-118 - Connecticut
| Pre Trial Drug Education Program Application Order Disposition Form. This is a Connecticut form and can be used in Criminal Statewide . |
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PRE-TRIAL DRUG EDUCATION PROGRAM APPLICATION, ORDER JD-CR-118 Rev. 7-12 C.G.S. § 54-56i Instructions 1. File the original of this application with the clerk of court. 2. Send a copy to the prosecuting attorney. 3. A $100 application fee and a nonrefundable $100 evaluation fee, or an application for waiver of the fees, must be filed with this application. Notice To Clerk: Seal the file on order of the court per C.G.S.§ 54-56i(b). www.jud.ct.gov To: The Superior Court of the State of Connecticut Geographical Address of court Area number Name of Applicant/Defendant The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation in accordance with the ADA, contact a court clerk or an ADA contact person listed at www.jud.ct.gov/ADA. CMIS case number Last 4 digits of Social Security number XXX-XXTelephone number Docket number Address of Applicant (Number, street, town, apartment number and zip code) Date of birth I have been charged with violating drug paraphernalia laws or drug possession laws (under section 21a-267 or section 21a-279 of the Connecticut General Statutes), and apply for the Pre-Trial Drug Education Program. I agree, if my application is granted, to the following: 1. To give the state more time to prosecute me (the tolling of any statute of limitations and waiver of the right to a speedy trial) for such crime(s) if I do not successfully complete the Program. 2. To begin my participation in the drug education program within 90 days from the day the court orders me to unless I am granted a delayed entry and I agree to complete participation in 10 or 15 sessions of the drug intervention program or substance abuse treatment program as recommended by the evaluation ordered by the court and after finishing the program, to accept treatment in a treatment program recommended by a DMHAS contractor or take part in a treatment program that has standards that are like or higher than the DMHAS contractor's program if the Court Support Services Division thinks I should. 3. To any conditions that may be set up by the Department of Mental Health and Addiction Services (DMHAS) concerning my taking part in the drug education program including conditions concerning my taking part in meetings or sessions of the program. (Section 53a-39c of the Connecticut General Statutes.) 4. That I take part in a community service labor program for at least 5 days if I am in a 10-session drug intervention program or a substance abuse treatment program; and if I am in a 15session drug intervention program that I take part in a community service labor program for at least 10 days. (Section 53a-39c of the Connecticut General Statutes). 5. To pay the court a non-refundable fee of $350 ( as may be changed by the legislature) to take part in the 10-session drug intervention program or $500 ( as may be changed by the legislature) to take part in the 15-session drug intervention program. I must pay for the costs of the substance abuse treatment program if I am ordered to participate in that program. If I cannot pay or am indigent, I will file with the court an affidavit telling the court why I cannot pay. I give my permission to the Court Support Services Division to get information about my prior participation in the Pre-Trial Drug Education Program and the Pre-Trial Community Service Labor Program in order to confirm that I am eligible for the Pre-Trial Drug Education Program. If I file an affidavit of inability to pay or indigency, the Court Support Services Division will look into whether I can pay and the court may decide that I do not have to pay all or any part of the program fee if it finds that I am indigent or unable to pay the fee to take part in this program. ("X" one of the following) I intend to claim an inability to pay or indigency. I intend to pay the program fee. By signing this form, I request that I be granted the Pre-Trial Drug Education Program (Section 54-56i of the Connecticut General Statutes). I have read the above and understand it. Signed (Applicant) Date signed Consented to by (Parent or Guardian) Oath The applicant stated under penalties of perjury before me, duly designated by the clerk and authorized to administer oaths, that (s)he has never previously participated in the Drug Education Program established under section 54-56i of the general statutes or the pre-trial community service labor program established under section 53a-39c of the Connecticut General Statutes. Signed (Duly authorized person) Print name of person signing at left Date signed First Order Of Court ("X" All that apply) (If the application is denied and the file ordered unsealed, consider ordering the applicant's social security number, date of birth and telephone number redacted.) The applicant's oath under section 54-56i of the Connecticut General Statutes The application is denied. was taken in open court. The application is granted. The court orders the court file sealed as to the public and refers the applicant to the Court Support Services Division for assessment and confirmation of the eligibility of the applicant and to DMHAS to evaluate the applicant. The case is continued until (date) _________________at (time) ___________a.m./p.m. to permit the Court Support Services Division to process the filed affidavit of indigency or inability to pay. Case continued to (Date and time) Signed (Judge, Assistant Clerk) Date signed (Page 1 of 2) American LegalNet, Inc. www.FormsWorkFlow.com Court Support Services Assessment And Confirmation Prior CSLP Prior program participation Able to pay program fee Assessment YES NO YES 15 Session Drug NO YES NO PARTIAL ELIGIBLE INELIGIBLE DHMAS evaluation recommendation (Report attached) 10 Session Drug Substance Abuse Treatment Signed (C.S.S.D. Officer) Second Order Of Court (If assessed ineligible or claim of indigency) (If the application is denied and the file ordered unsealed, consider ordering the applicant's social security number, date of birth and telephone number redacted.) The court, having determined that the applicant is ineligible, denies the application and the court file is ordered to be unsealed, a plea of not guilty entered and this case to be immediately placed on the trial list. The application is granted and the defendant is referred to the Court Support Services Division for referral to the Department of Mental Health and Addiction Services for placement in a 10-session or 15
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