Free PRE-TRIAL ALCOHOL EDUCATION SYSTEM - Connecticut

PRE-TRIAL ALCOHOL EDUCATION SYSTEM
APPLICATION, ORDER, DISPOSITION
JD-CR-44 Rev. 6-09 C.G.S. § 14-227a, 14-227g, 54-56g, P.A. 09-140

Instructions To Person Filling Out This Application 1. File the original of this application with the clerk of court. 2. Send a copy to the prosecuting attorney. 3. A $50.00 application fee and a nonrefundable $100 evaluation fee, or an application for waiver of the fees, must be filed with this application.

www.jud.ct.gov
CSSD Case Number Docket Number

TO: The Superior Court of the State of Connecticut
Geographical Area Number Address of Court Sex Operator's Number Social Security Number

Name of Applicant/Defendant

Date of Birth Telephone Number

Address of Applicant (Number, street, town and apartment number)

I am charged with operating a motor vehicle while under the influence of liquor or drug or while having an elevated blood alcohol content; being under 21 (twenty-one years of age) and operating a motor vehicle while my blood alcohol content was more than .02% (two-hundredths of one per cent); operating a vessel while under the influence of liquor or drugs; recklessly operating a vessel in the 1st degree while under the influence of intoxicating liquor or drugs; recklessly operating a vessel in the 2nd degree; or manslaughter in the 2nd degree with a vessel (in violation of General Statutes §§14-227a, 14-227g, 15-133, 15-140l or 15-140n; or section 1 of Public Act 09-140). I am applying for participation in the Pre-Trial Alcohol Education System. If my application is granted: 3. I agreed to participate in at least 1 (one) victim impact panel, if 1. I agree to give the state more time to prosecute me for this the court orders me to. charge (the tolling of any statute of limitations with respect to this 4. If I decide to enter the program after the suspension of my license violation and to waive my right to a speedy trial). is over, I agree to tell CSSD the date my license was suspended 2. I agree to finish 10 or 15 counseling sessions in an alcohol and how long my license was suspended for. intervention program or to finish a substance abuse treatment 5. I agree to pay the court a nonrefundable program fee of $325 if I program of at least 12 sessions, depending on the evaluation am ordered into the 10 session alcohol intervention program, or report and the court order; and when I finish the alcohol $500 if I am ordered into the 15 session alcohol intervention intervention program, to be placed in a treatment program program (these fees may be changed by the legislature), or to recommended by a provider under contract with the Department pay the costs of being in a treatment program if I am ordered into of Mental Health and Addiction Services (DMHAS) or to be a treatment program, except that if I cannot pay or if I am placed in a state-licensed treatment program which meets indigent, I will file with the court an affidavit saying I cannot pay or standards set by DMHAS if the Court Support Services Division that I am indigent. (CSSD) decides I should. I give my permission to CSSD to get information about any criminal or motor vehicle program I may have been in in this state or in any other jurisdiction so that CSSD can decide if I can be accepted into the system. If I am telling the court that I cannot pay or that I am indigent by filing an affidavit of my inability to pay or of my indigency, I give my permission to CSSD to get information to decide if I cannot pay or if I am indigent. ("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 am saying that I understand all of the above and I request that I be granted Pre-Trial Alcohol Education (Connecticut General Statutes § 54-56g).
I have read this entire application and I understand it. Signed (Applicant) Date Signed Consented to By (Parent or guardian)

Notice

Unless good cause is shown, a person is not eligible for the Pre-Trial Alcohol Education System if the alleged violation of section 14-227a or 14-227g caused the serious physical injury, as defined in section 53a-3, of another person.

Oath
The applicant stated under penalties of perjury before me, duly designated by the clerk and authorized to administer oaths, that (1) if (s)he is charged with a violation of General Statutes § 14-227a, (s)he has not had the Pre-Trial Alcohol Education System invoked in his/her behalf within the preceding ten (10) years for a violation of General Statutes § 14-227a, (2) if (s)he is charged with a violation of General Statutes § 14-227g, (s)he has never had the Pre-Trial Alcohol Education System invoked in his/her behalf for a violation of General Statutes § 14-227a or General Statutes § 14-227g, and that (s)he has not been convicted of a violation of General Statutes §§ 53a-56b or 53a-60d, a violation of subsection (a) of General
Signed (Duly authorized person)

Statutes § 14-227a before or after October 1, 1981, or a violation of subdivision (1) or (2) of subsection (a) of General Statutes § 14-227a on or after October 1, 1985, and that (s)he has not been convicted in any other state at any time of an offense the essential elements of which are substantially the same as General Statutes §§ 53a-56b or 53a-60d or subdivision (1) or (2) of subsection (a) of General Statutes § 14-227a, and (3) if (s)he is charged with a violation of General Statutes § 14-227a, (s)he was not operating a commercial motor vehicle as that term is defined in General Statutes § 14-1.
Date Signed

Print Name of Person Signing at Left

First Order of Court
("X" all that apply)

The foregoing application is denied. The applicant's oath under General Statutes § 54-56g was taken: ("X" one) in open court. outside of court by a person duly designated by the clerk and authorized to administer oaths.
(Continued...)

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First Order of Court - Continued
at (time) .m. to consider the Court Support Services The case is continued until (date) Division assessment of eligibility and the Department of Mental Health and Addiction Services evaluation and/or the applicant to file an affidavit of indigency and for the Court Support Services Division to seek to confirm such indigency. The Court orders the court file sealed as to the public.
Case Continued To (Date and time) Signed (Judge, Assistant Clerk) Date Signed

Court Support Services Division Assessment and Confirmation
Chemical Analysis Results (Specify BAC) Out-of-state D.W.I. Conviction Prior § 14-227a Conviction Prior § 14-227g Conviction

Yes
Charged With Violating § 14-227a and Holds a Commercial Driver's License

No

Yes

No

Yes

No

Yes
Prior System Participation

No
Able to Pay Program Fee Assessment

Yes, date: 10 Session Alcohol

No 15 Session Alcohol

Yes

No (Affidavit attached) Substance Abuse Treatment

Eligible
Signed (CSSD Officer)

Ineligible

DHMAS Evaluation Recommendation (Report attached)

Second Order of Court
(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 defendant is ineligible, denies the foregoing application and the court file is ordered to be unsealed, a plea of not guilty entered and this case is to be immediately placed on the trial list. The foregoing application is granted and the applicant is referred to the Court Support Services Division for referral to the Department of Mental Health and Addiction Services for placement in an appropriate alcohol intervention program for one year or to be placed in a state-licensed substance abuse treatment program. The applicant has opted to enter the program: without delay when the period of the applicant's license suspension pursuant to General Statutes § 14-227b, is completed. The applicant is ordered to notify the Court Support Services Division of the date the applicant's license was suspended and the length of the suspension. The defendant shall participate in one victim impact panel. The program fee is: $325 (10 sessions) $500 (15 sessions) and the applicant is ordered to forthwith pay the clerk the nonrefundable program fee unless the fee is waived below. The court denies the application for waiver of fees and the accused is ordered to pay to the clerk forthwith the statutory program fee. The court waives the fee having found that the applicant is indigent or unable to pay. The substance abuse treatment program costs shall be paid by the applicant unless the costs are ordered paid by the state below. The court denies the application for waiver of costs and the accused is ordered to pay all costs associated with participation in the substance abuse treatment program. The court waives the accused's obligation to pay the cost of participation in the treatment program and the costs of the treatment program shall be paid from the pretrial account established under Connecticut General Statutes § 54-56k, having found the applicant is indigent or unable to pay.
Case Continued To (Date and time) Signed (Judge, Assistant Clerk) Date Signed

Third Order of Court (If motion for extension filed)
The defendant's motion for extension of the one-year placement period to complete the assigned program: is DENIED. is GRANTED. The period is extended to the date shown below, the defendant having established good cause for such extension.
Case Continued To (Date and time) Signed (Judge, Assistant Clerk) Date Signed

Final Progress Report
The defendant: ("X" one only). HAS satisfactorily completed the assigned program. HAS satisfactorily completed the assigned program, but has a new DWI charge pending. HAS NOT satisfactorily completed the assigned program. is no longer amenable to treatment under the program.
Signed (CSSD Officer) Date Signed

Disposition
(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.)

Program satisfactorily completed and charges dismissed. Program not satisfactorily completed, or the defendant is no longer amenable to treatment under the program. The court file is to be unsealed, a plea of not guilty entered and this case to be immediately placed on trial list.
Signed (Judge, Assistant Clerk) Date Signed

JD-CR-44 (Back) Rev. 6-09

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