Free Diversion Record - Michigan

Approved, SCAO

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

COUNTY
Court address

DIVERSION RECORD

CASE NO. PETITION NO.

Court telephone no.

1. Minor's name
Minor's address Father's name Father's address Mother's name Mother's address Alleged offense for which minor was apprehended Date and place of alleged offense

Date of birth

2. The following factors have been examined in connection with this case. a. the nature of the alleged offense, b. the minor's age, c. the nature of the problem that led to the alleged offense, d. the minor's character and conduct, and e. the minor's behavior in school, family, and group settings. 3. The minor has not been previously diverted. The minor has been previously diverted. The minor's compliance on the prior referral was 4. A conference has been held to consider diversion alternatives. released. referred to the program located at .
Date Signature of intake worker or law enforcement official Name (type or print) Agency Address City, state, and zip

satisfactory. unsatisfactory.

5. The minor was

6. Date:
Signature

Compliance with the diversion agreement to date has been

satisfactory. unsatisfactory.

Do not write below this line - For court use only

JC 55 (6/03)

DIVERSION RECORD

MCL 722.821 et seq., MCR 3.932(A)