Free PRE-TRIAL DRUG EDUCATION PROGRAM APPLICATION, ORDER, DISPOSITION - Connecticut

PRE-TRIAL DRUG EDUCATION PROGRAM APPLICATION, INSTRUCTIONS ORDER, DISPOSITION 1. File the original with the clerk of court; send a copy to the prosecuting attorney.
JD-CR-118 Rev. 4-08 C.G.S. § 54-56i 2. If you are going to claim that you are indigent or cannot pay, you must file a written statement that you swear under oath that you are indigent or unable to pay (an affidavit of indigency or inability to pay) with this application.

NOTICE TO CLERK: Seal the file on order of the court per C.G.S.§ 54-56i(b).

TO: The Superior Court of the State of Connecticut
G.A. No. Address of Court Sex

www.jud.ct.gov

CMIS Case No. Docket No.

Name of Applicant/Defendant Address of Applicant (Number, street, town and apt. no.)

Social Security No.

Date of Birth Telephone No.

I have been charged with violating drug paraphernalia laws or drug possession laws (under Gen. Stat. § 21a-267 or § 21a-279), and apply for participation in the Pre-Trial Drug Education Program. I agree, if my application is granted, to the following: 1. To give the state more time to prosecute me (the tolling of any statute of limitations and waiver of the right to a speedy trial) for such crime(s) if I do not successfully complete the Program. 2. To any conditions that may be set up by the Department of Mental Health and Addiction Services (DMHAS) concerning my taking part in the drug education program including conditions concerning my taking part in meetings or sessions of the program. The department will require, as a condition of the program, that I take part in, and successfully complete, a 4-day community service labor program (Gen. Stat. §53a-39c) . 3. To take part in a treatment program recommended by a DMHAS contractor or take part in a treatment program that has standards that are like or higher than the DMHAS contractor's program if the Court Support Services Division thinks I should. 4. To pay the court a non-refundable fee of $350 (as may be changed by the legislature) to take part in the Drug Education Program, except that if I am indigent or cannot pay, I will file with the court an affidavit telling the court why I cannot pay.

I give my permission to the Court Support Services Division to get information about my prior participation in the Pre-Trial Drug Education Program and the Pre-Trial Community Service Labor Program in order to confirm that I am eligible for the Pre-Trial Drug Education Program. If I file an affidavit of indigency or inability to pay, the Court Support Services Division will look into whether I can pay and the court may decide that I do not have to pay all or any part of the program fee if it finds that I am indigent or unable to pay the fee to take part in this program. By signing this form, I request that I be granted the Pre-Trial Drug Education Program (Gen. Stat. 54-56i). I have read the above and understand it.
Signed (Applicant) Date Signed Consented to by (Parent or guardian)

X

OATH
The applicant stated under penalties of perjury before me, duly designated by the clerk and authorized to administer oaths, that (s)he has never previously participated in the Drug Education Program established under section 54-56i of the general statutes or the pre-trial community service labor program established under Sec. 53a-39c of the general statutes.
Signed (Duly authorized person) Print Name of Person Signing at Left Date Signed

FIRST ORDER OF COURT
("X" ALL THAT APPLY) (If the application is denied and the file ordered unsealed, consider ordering he applicant's social security number, date of birth and telephone number redacted.)

The foregoing application is denied.

The applicant's oath under Gen. Stat. 54-56i was taken in open court.

The foregoing application is granted. The court orders the court file sealed as to the public and refers the applicant to the Court Support Services Division for assessment and confirmation of the eligibility of the applicant. If the Court Support Services Division confirms that the applicant is eligible, the Court Support Services Division shall refer the applicant to the Department of Mental Health and Addiction Services for evaluation and placement in an appropriate drug program, and require the applicant to participate in, and successfully complete, a community service labor program established under section 53a-39c for a period of 4 days. The applicant is to forthwith pay the clerk a nonrefundable three hundred and fifty dollar program fee. The case is continued until (date) _________________at (time) ___________a.m./p.m. to permit the Court Support Services Division to process the filed affidavit of indigency or inability to pay.
Case Continued To (Date and time) Signed (Judge, assistant clerk) Date Signed

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COURT SUPPORT SERVICES ASSESSMENT AND CONFIRMATION
Prior CSLP Prior Program Participation Able To Pay Program Fee Assessment

YES

NO

YES

NO

YES

NO

PARTIAL

ELIGIBLE

INELIGIBLE

Signed (C.S.S.D. Officer)

X
SECOND ORDER OF COURT (If assessed ineligible or claim of indigency)
(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 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 evaluation and placement in an appropriate drug program which shall require the applicant to participate in, and successfully complete, a four-day community service labor program established under section 53a-39c. 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 court waives a portion of the fee, having found that the applicant is unable to pay the full fee. The applicant is ordered to pay the clerk forthwith $ _____________________ as payment for the program fee.
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 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

FOURTH ORDER OF COURT (If request to attend out-of-state program) The defendant's request to attend a program in another state that has standards similar to, or higher than, those of Connecticut, due to the defendant's employment or residence or schooling making it unreasonable to attend a drug program in Connecticut: is GRANTED, subject to the payment of the program fee provided by statute unless the fee is waived above (see second order of the court). is DENIED.
Case Continued To (Date and time) Signed (Judge, assistant clerk) Date Signed

FINAL PROGRESS REPORT Drug Education: ("X" one only). HAS satisfactorily completed the assigned program. HAS NOT satisfactorily completed the assigned program. Community Service: ("X" one only). HAS satisfactorily completed community service. HAS NOT satisfactorily completed community service.
Signed (C.S.S.D. 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 and community service satisfactorily completed and charges dismissed. Program and/or community service not satisfactorily completed. 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-118 (Page 2 of 2) Rev. 4-08

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