Application For 21st Drug Court

21st DRUG COURT APPLICATION Date: ___________ Applicant's Full Name:_____________________________________________________ Soc. Sec No. ______________________Date of Birth______________________ Sex_______________________________Race:___________________________ Local Residence Address:___________________________________________________ Are you currently in jail? _______If so, what is your release date?___________________ If not in jail, how can you be contacted? _______________________________________ What is your lawyers name, address and phone numbers: _________________________ ________________________________________________________________________ What are you current charges? _______________________________________________ What is your docket number ________________________________________________ Do you have a pending court date? ___________________________________________ Which court/Judge__________________________________________________ List all previous convictions: ________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Please return to Marianne Schroer, Drug Court Coordinator Fax: (615) 595-2591 Office is located at 105 Southeast Parkway, Suite 104, Franklin, TN 37064 Mailing address is P.O. Box 757, Franklin, TN 37065 American LegalNet, Inc. www.FormsWorkFlow.com