Form Center

Identifying Information

NOTE: This form is for Pretrial Diversion participants only and is not appropriate for individuals hoping to check-in for the pre-trial release program.
Pretrial release is not a part of the Prosecutor's Office but may be reached at 317-776-9672.
First Name*
Middle Initial
Last Name*
Address1*
Address2
City*
State*
Zip*
Date of Birth*
Phone Number*
E-Mail Address*
Cause Number
This is the number associated with the court case and will begin with 29D, 29C, or 29H. (Example of a cause number and the format to be used: 29D04-1706-CM-001234)
Continue

Updates

Provide an update on progress made in the last thirty (30) days on your special conditions (e.g., community service or counseling).*
Be specific in your description
Do you need a new community service form?*
Note: the form provided by our office is the only form that will be accepted.
Download a blank form
Blank Community Service Form
If you need a personalized form, please request one in the next box.
How would you like that to be sent to you?
Your request will be responded to within five (5) business days.
Have you had a CHANGE in any of the following since your last check-in?
NOTE: These items require notification within seven days of any change
Address?*
Is the new address entered on the last page?
New Address:
Enter new address
Phone Number?*
Enter New Phone Number here:
Employment?*
Describe the changes
Education Enrollment/Attendance?*
Describe the changes
Are you currently enrolled and attending school (college, university, etc.)?*
Have you had ANY official contact with law enforcement since your last check-in?*
NOTE: Any such contact must be reported within twenty-four (24) hours of the contact.
Describe the contact(s).
Include as much detail as possible, including, but not limited to: date, time, location, agency involved, other parties involved, type of contact, whether any complaint and summons (ticket) was issued to anyone, and whether anyone was arrested.
Will you be away from home for seven (7) days or more in the next thirty (30) days?*
Destination and dates of travel
Continue |Go Back

Finalize

WARNING!
The knowing or intentional use of the identifying information of another person without the person's consent and with the intent to harm or defraud another person or to assume another person's identity or to profess to be another person constitutes the crime of identity deception, a felony.
Are you the individual who is on pre-trial diversion and to whom all of this form's responses apply?*
Type 'yes' to agree.
WARNING!
Answering untruthfully may result in you being terminated from the pre-trial diversion program.
Are the answers you provided on the previous pages true to the best of your knowledge?*
Type 'yes' to agree

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
Submit | Go Back

Search Forms:

Pretrial Diversion Check-In

Steps

Identifying Information

Updates

Finalize

Quick Links

Site Links