Application For Admission Into Veterans Treatment Court Application For Admission Into Veterans Treatment Court - California by AmericanLegalNet

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Application For Admission Into Veterans Treatment Court Form. This is a California form and can be use in San Mateo Local County.

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									                       SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN MATEO
THE PEOPLE OF THE STATE OF CALIFORNIA                                            Case Number(s):
                                     Plaintiff,
                     vs.

                                                                Defendant
                  APPLICATION FOR ADMISSION INTO
                    VETERANS TREATMENT COURT

1.     I, ____________________________, am an Active Duty Member, or a Veteran with an Honorable or
       General Discharge, of the United States Armed Services.

2.     I understand that:
       a. To be considered for this program, signed copies of this Application and the Consent to
            Release of Confidential Information forms must be delivered to:
              i. Service Connect Office, County of San Mateo Hall of Justice and Records, 1 st Floor, 400
                 County Center, Attn: Veterans Court Clinician Daniel Gunther (Fax 650-701-0277); and,
              ii. Adult Probation, County of San Mateo, Hall of Justice and Records, 400 County Center, 5th
                  Floor, Redwood City, CA, Attn: Michael Leon (Fax 650-363-4829).
       b.     Veterans Treatment Court involves a long-term treatment program and probation terms.
       c.     If admitted, I will be subject to Veterans Treatment Court rules, which may include electronic
              monitoring, drug testing, and, for any rules violations, flash incarcerations.
       d.     Any restitution that I owe to any victim of a crime I have committed will remain due and
              payable until paid, even if I complete Veterans Treatment Court.
3.     My full name, address and phone number are:
       _____________________________________________________________________________________
       _____________________________________________________________________________________
4.     I am represented by: (name, address & telephone number of your attorney, if you have one)
       _____________________________________________________________________________________
       _____________________________________________________________________________________
5.     I have been convicted of the following charges (or have admitted the following Probation Violations)
       in San Mateo County Superior Court Case Number indicated above:
       _____________________________________________________________________________________
       _____________________________________________________________________________________
6.     I am asking to be admitted into Veterans Treatment Court because: (if more space needed, attach
       additional page):
       ____________________________________________________________________________________
       ____________________________________________________________________________________
I, ____________________________, understand all of the above, and acknowledge that everything I have
said about myself in the preceding answers is true.

Dated:                                            ________________________________________
                                                              Veteran’s Signature               Additional page attached

Form adopted for Mandatory Use      APPLICATION   FOR ADMISSION INTO VETERANS TREATMENT COURT               Pen.Code § 1170.9
Local Court Form VTC 01 [Rev. May 2012]
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