Drug Court Application

Drug Court Application

Applicant Information

Defendant Last Name*

Defendant First Name*

Date of Birth*

Is this a new case for a current SLCO Drug Court participant?*

Yes

Current Drug Court Judge

Select or enter value

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

Sex

Select

Ethnicity / Race

Select

Education

Select

Employment

Select

Substance Use and Treatment History

Substances Used*

How were they used (smoking, IV, etc.)

Length of use for each substance

Treatment History

Is the applicant a former drug court participant?

This includes criminal, family dependency, and DUI courts

Yes

Did applicant graduate prior Drug Court?

Yes

Year applicant graduated or was sentenced out

Case Information

Case(s)*

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

Is the defendant currently on probation or parole?

Yes

List any cases for which the defendant is already on AP&P

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.

Are there any cases from outside of Salt Lake County that you will be asking to transfer?

Judicial District, County, Judge

Prosecutor name, email address

Is the applicant currently incarcerated*

Yes

SO Number

Which Jail?

Case Number(s) with holds

Defense Attorney Name*

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

Defense Attorney Email Address*

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

Public Defender or Privately Retained*

Select

Assigned Prosecutor*

Does the prosecutor support this application?*

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

Yes

Prosecutor Email*

If these cases are assigned to more than one prosecutor, check below.

Enter prosecutor name, email, and whether they support this application for their case(s).

(i.e. Todd Olsen, TOlsen@slco.org, Supports Application)

Judge*

Select or enter value

Next Court Date*

Does the defendant have other open 3rd District cases?*

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.

Yes

Supervising Agency

Name of Agent

Contact Information

Housed or Unhoused*

Select

Defendant's Salt Lake County Address*

Or the address they intend to occupy once released

Persons who live there

Defendant's Telephone Number

Defendant's Email Address

Applicant or Attorney Signature*

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.

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.

Send me a copy of my responses

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