Free APPLICATION FOR SUPERVISED DIVERSIONARY PROGRAM - Connecticut

APPLICATION FOR SUPERVISED DIVERSIONARY PROGRAM
JD-CR-154 Rev. 5-09 C.G.S. § 54-56l

Notice to Clerk:

Seal the file on order of the court per
C.G.S. § 54-56l www.jud.ct.gov

Instructions to Applicant 1. Complete Section I. 2. Keep the goldenrod copy for your records.

Instructions to Clerk 1. Retain white copy in the court file. 2. Give yellow copy to CSSD and pink copy to the State's Attorney.

Section I
TO: The Superior Court of the State of Connecticut
G.A. number Address of Court Name of Applicant/Defendant Address of Applicant (Number, street, town and apartment number) Sex

CMIS number Docket number Year of Birth

Female

Male
Telephone number

I have a psychiatric disability that is a mental or emotional condition that is not just substance abuse. Without proper care and treatment, the psychiatric disability strongly sets back (has substantial adverse effects on) my ability to function. I have been accused of one or more crimes or one or more motor vehicle violations which could result in a jail sentence. The crimes or violations are not serious. I am applying for the Supervised Diversionary Program. If my application is granted, I agree 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) if I do not successfully finish the Program. 2. To any condition that may be set up by the Court Support Services Division (CSSD) about my taking part in the Supervised Diversionary Program including conditions about my taking part in meetings, treatment or sessions of the Program.

I give my permission to the Court Support Services Division to get information about my prior participation in the Supervised Diversionary Program or my eligibility to participate in the pretrial program for accelerated rehabilitation under General Statutes § 54-56e(c). I understand that details of my mental or emotional condition may be made known to the court and may become part of my court file. By signing this form, I am saying that I understand all of the above and I request that I be granted the Supervised Diversionary Program (C.G.S. § 54-56l). I have read or have had the above read to me and I understand it.
Signed (Applicant, or Parent or Guardian if Applicant is minor) Date signed

Section II
Oath The applicant stated under penalties of perjury before me, duly designated by the clerk and authorized to administer oaths, that (s)he has not previously participated in the Supervised Diversionary Program established under C.G.S. § 54-56l more than once.
Signed (Duly authorized person) Print name of person signing at left Date signed

Distribution:

White -- Court file

Yellow -- CSSD

Pink -- State's Attorney (Page 1 of 2)

Goldenrod -- Applicant

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First Order of Court
("X" ALL THAT APPLY) (If the application is denied and the file ordered unsealed, consider ordering the applicant's telephone number redacted.) The foregoing application is denied. The applicant's oath under C.G.S. § 54-56l 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 CSSD for confirmation of eligibility and assessment of the applicant's mental health condition. The State's Attorney shall provide CSSD with a copy of the police report. The case is continued until
(date) Signed (Judge, Assistant Clerk)

at
(time)

a.m./p.m.
Date Signed

Court Support Services Division Assessment and Confirmation
Prior participation in Supervised Diversionary Program Assessment
Signed (CSSD Officer)

One Time

Two Times

No Yes No
Date Signed

Eligible for Accelerated Rehabilitation under subsection (c) of General Statutes § 54-56e Eligible Ineligible

Second Order of Court
(If the application is denied and the file ordered unsealed, consider ordering the applicant's telephone number redacted and the victim notification (JD-CR-153) sealed.) 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. Based upon the information provided by the Court Support Services Division, the court finds that appropriate services and treatment are not available for this defendant at this time. The court, upon confirmation of the defendant's eligibility and after considering the treatment plan presented by the Court Support Services Division for this defendant, grants the foregoing application and the applicant is referred to the Court Support Services Division for supervision pursuant to the Supervised Diversionary Program. The case is continued until
(date) Signed (Judge, Assistant Clerk)

at
(time)

a.m./p.m.
Date Signed

Final Progress Report
The Defendant has satisfactorily completed the assigned program. The Defendant has not satisfactorily completed the assigned program because (Explain):

Signed (CSSD Officer)

Date Signed

Disposition
(If the court file is ordered to be unsealed and a plea of not guilty entered, consider ordering the applicant's telephone number redacted and the victim notification (JD-CR-153) sealed.) Program satisfactorily completed and charges dismissed. Program not satisfactorily completed because (Explain): 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) JD-CR-154 Rev. 5-09 Date Signed

(Page 2 of 2)

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