Drug Court Application

 

Applicant Information

 
 
 
 
mm/dd/yyyy
 
 

 

Demographic Info

This information is for research purposes only and will not be used in determining admission to a specialty court program. This section will be removed before it is reviewed by a prosecuting attorney

 
 
 
 
 

 

Substance Use and Treatment History

 
 
 
 
 

This includes criminal, family dependency, and DUI courts

 

 

Case Information

 

Include every District Court case you would like considered for drug court.

 
 

NOTE. The court has informed us that any unpaid supervision fees will be automatically sent to the Office of State Debt when the defendant converts probation to drug court. Please ensure your client is aware of this.

 
 
 

If multiple attorneys represent this defendant you may include their names.

 

If multiple attorneys, select a primary attorney's email address.

 
 
 

The assigned prosecutor's input will be considered but the treatment court team will make the final decision regarding admission.

 
 
 
 
 
mm/dd/yyyy
 

Open cases that are not included in this application will not be accepted later. It is your responsibility to make sure this application is complete. If the applicant is represented by another lawyer in your firm on other cases, it is your responsibility to coordinate with that attorney and include all open cases.

 

 

Contact Information

 
 
 
 

By signing this form I acknowledge the following:


I have a substance abuse problem or significant mental health diagnosis for which I am seeking admission to a therapeutic court program.

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I understand that the opportunity to participate in this program is a privilege, not a right. I acknowledge that if I am accepted, there will be rules and responsibilities that I will be expected to follow that will include treatment and frequent drug screens. I understand that I can expect to receive incentives when I progress in the program and sanctions when I do not.


I further hereby grant permission to disclose and deliver to Treatment Court Personnel, Criminal Justice Service Personnel assigned to screening for specialty courts, the Deputy District Attorney assigned to the treatment court, the Legal Defender assigned to the treatment court, and counsel representing me, any and all information contained in this application and any subsequent records from any Salt Lake County Court/District Attorney’s Office. Such information may include my criminal history, medical, mental health, and psychiatric record information. This information is used in reference to decisions related to my involvement and participation in a therapeutic court program.


I swear the statements in this application are true, correct and complete to the best of my knowledge. I understand and agree that this application shall be used solely for treatment court screening purposes, is part of a plea negotiation and will not be used against me as evidence in a court of law.


If I am an attorney signing on behalf of a client, I attest that I have received the client's authorization to do so and I am acting on their behalf.

 

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