Form JD-CR-118 "Pretrial Drug Education and Community Service Program Application" - Connecticut

What Is Form JD-CR-118?

This is a legal form that was released by the Connecticut Superior Court - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2016;
  • The latest edition provided by the Connecticut Superior Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form JD-CR-118 by clicking the link below or browse more documents and templates provided by the Connecticut Superior Court.

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Download Form JD-CR-118 "Pretrial Drug Education and Community Service Program Application" - Connecticut

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STATE OF CONNECTICUT
PRETRIAL DRUG EDUCATION AND
SUPERIOR COURT
COMMUNITY SERVICE PROGRAM APPLICATION
JUDICIAL BRANCH
JD-CR-118 Rev. 10-16
www.jud.ct.gov
C.G.S. § 54-56i; P.A. 16-167 § 45
Instructions to Defendant
1. File the original of this application with the Clerk of Court.
ADA Notice
2. Send a copy to the prosecuting attorney.
The Judicial Branch of the State of Connecticut
3. A $100 application fee and a nonrefundable $150 evaluation fee, or an
complies with the Americans with Disabilities Act
application for waiver of the fees, must be filed with this application.
(ADA). If you need a reasonable accommodation in
accordance with the ADA, contact a court clerk or an
Notice To Clerk: Seal the file on order of the court per C.G.S. § 54-56i(b).
ADA contact person listed at www.jud.ct.gov/ADA.
TO: The Superior Court of the State of Connecticut
Address of court
Docket number
GA/JD
number
Name of defendant
Address of defendant (Number, street, apartment number, town, and zip code)
CMIS case number
Alias/Maiden name of defendant
Telephone number of defendant
Offense(s) charged
Prior Participation
Have you previously been allowed into the Pretrial Drug Education Program that was in effect before October 1, 2013, the Community Service Labor
Yes
No
Program, or the Pretrial Drug Education and Community Service Program?
If yes, how many times have you been allowed into any of these programs?
1
2
3 or more.
Military Status
Have you ever served in the U.S. Armed Forces, including the Connecticut National Guard
Yes
No
(as defined in section 27-103 of the Connecticut General Statutes)?
If you have ever served in the armed forces: (“X” one)
I am an active member of the armed forces.
I was discharged or released from active service in the armed forces honorably or under conditions other than dishonorable.
I was dishonorably discharged from active service in the armed forces.
Application
I have been charged with violating drug paraphernalia laws or drug possession laws under section 21a-267, 21a-279, or 21a-279a of the Connecticut
General Statutes, and apply for the Pretrial Drug Education and Community Service 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 the offense(s) listed above if
I do not successfully complete the Program.
2. To begin the Drug Education Program within 90 days of the day that the court orders me into the program, unless the court gives me more time to start the
program. I understand that the court will order an evaluation of me that will determine whether I have to go to 15 sessions of a drug education program or
at least 15 sessions of a substance abuse treatment program. After finishing the program that the court orders me into, if the Court Support Services
Division (CSSD) thinks I need more treatment, I agree to accept any additional treatment in a treatment program recommended by a Department of Mental
Health and Addiction Services (DMHAS) contractor, or the Connecticut Department of Veterans Affairs or the United States Department of Veterans
Affairs if I am a veteran and either of those organizations are treating me, or to go into another treatment program that has standards that are at least as
high or higher than the DMHAS contractor's program.
3. To follow any conditions that may be set up by DMHAS, the Connecticut Department of Veterans Affairs, or the United States Department of Veterans
Affairs, concerning my taking part in the drug education program including conditions concerning my taking part in meetings or sessions of the program.
4. That I will take part in a community service labor program set up under section 53a-39c of the Connecticut General Statutes for at least five days if this is
the first time that I have been allowed into the drug education and community service program, at least 15 days if this is second time that I have been
allowed into the program, or at least 30 days if this is the third or additional time that I have been allowed into the program.
5. To pay the court a non-refundable fee of $600 (as may be changed by the legislature) to take part in the drug education program or $100 (as may be
changed by the legislature) to take part in a substance abuse treatment program. I understand that I must also pay for the costs of the substance abuse
treatment program if I am ordered to take part in that program. If I cannot pay or am indigent, I will file with the court an affidavit telling the court why I
cannot pay.
I give my permission to CSSD to get information about my prior participation in the Pretrial Drug Education Program, the Pretrial Drug Education and
Community Service Program, and the Community Service Labor Program in order to confirm that I am eligible for the Pretrial Drug Education and Community
Service Program.
If I file an affidavit of inability to pay or indigency, CSSD 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. ("X" one of the following)
I plan to claim that I cannot pay or that I am indigent.
I plan to pay the program fee(s).
By signing this form, I request that I be allowed into the Pretrial Drug Education and Community Service Program
under section 54-56i of the Connecticut General Statutes.
Signed (Defendant)
Date signed
I have read the above
Consented to by (Parent or Guardian)
information and understand it.
Signed (Duly authorized person)
Print name
Date signed
(Page 1 of 2)
Print Form
Reset Form
STATE OF CONNECTICUT
PRETRIAL DRUG EDUCATION AND
SUPERIOR COURT
COMMUNITY SERVICE PROGRAM APPLICATION
JUDICIAL BRANCH
JD-CR-118 Rev. 10-16
www.jud.ct.gov
C.G.S. § 54-56i; P.A. 16-167 § 45
Instructions to Defendant
1. File the original of this application with the Clerk of Court.
ADA Notice
2. Send a copy to the prosecuting attorney.
The Judicial Branch of the State of Connecticut
3. A $100 application fee and a nonrefundable $150 evaluation fee, or an
complies with the Americans with Disabilities Act
application for waiver of the fees, must be filed with this application.
(ADA). If you need a reasonable accommodation in
accordance with the ADA, contact a court clerk or an
Notice To Clerk: Seal the file on order of the court per C.G.S. § 54-56i(b).
ADA contact person listed at www.jud.ct.gov/ADA.
TO: The Superior Court of the State of Connecticut
Address of court
Docket number
GA/JD
number
Name of defendant
Address of defendant (Number, street, apartment number, town, and zip code)
CMIS case number
Alias/Maiden name of defendant
Telephone number of defendant
Offense(s) charged
Prior Participation
Have you previously been allowed into the Pretrial Drug Education Program that was in effect before October 1, 2013, the Community Service Labor
Yes
No
Program, or the Pretrial Drug Education and Community Service Program?
If yes, how many times have you been allowed into any of these programs?
1
2
3 or more.
Military Status
Have you ever served in the U.S. Armed Forces, including the Connecticut National Guard
Yes
No
(as defined in section 27-103 of the Connecticut General Statutes)?
If you have ever served in the armed forces: (“X” one)
I am an active member of the armed forces.
I was discharged or released from active service in the armed forces honorably or under conditions other than dishonorable.
I was dishonorably discharged from active service in the armed forces.
Application
I have been charged with violating drug paraphernalia laws or drug possession laws under section 21a-267, 21a-279, or 21a-279a of the Connecticut
General Statutes, and apply for the Pretrial Drug Education and Community Service 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 the offense(s) listed above if
I do not successfully complete the Program.
2. To begin the Drug Education Program within 90 days of the day that the court orders me into the program, unless the court gives me more time to start the
program. I understand that the court will order an evaluation of me that will determine whether I have to go to 15 sessions of a drug education program or
at least 15 sessions of a substance abuse treatment program. After finishing the program that the court orders me into, if the Court Support Services
Division (CSSD) thinks I need more treatment, I agree to accept any additional treatment in a treatment program recommended by a Department of Mental
Health and Addiction Services (DMHAS) contractor, or the Connecticut Department of Veterans Affairs or the United States Department of Veterans
Affairs if I am a veteran and either of those organizations are treating me, or to go into another treatment program that has standards that are at least as
high or higher than the DMHAS contractor's program.
3. To follow any conditions that may be set up by DMHAS, the Connecticut Department of Veterans Affairs, or the United States Department of Veterans
Affairs, concerning my taking part in the drug education program including conditions concerning my taking part in meetings or sessions of the program.
4. That I will take part in a community service labor program set up under section 53a-39c of the Connecticut General Statutes for at least five days if this is
the first time that I have been allowed into the drug education and community service program, at least 15 days if this is second time that I have been
allowed into the program, or at least 30 days if this is the third or additional time that I have been allowed into the program.
5. To pay the court a non-refundable fee of $600 (as may be changed by the legislature) to take part in the drug education program or $100 (as may be
changed by the legislature) to take part in a substance abuse treatment program. I understand that I must also pay for the costs of the substance abuse
treatment program if I am ordered to take part in that program. If I cannot pay or am indigent, I will file with the court an affidavit telling the court why I
cannot pay.
I give my permission to CSSD to get information about my prior participation in the Pretrial Drug Education Program, the Pretrial Drug Education and
Community Service Program, and the Community Service Labor Program in order to confirm that I am eligible for the Pretrial Drug Education and Community
Service Program.
If I file an affidavit of inability to pay or indigency, CSSD 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. ("X" one of the following)
I plan to claim that I cannot pay or that I am indigent.
I plan to pay the program fee(s).
By signing this form, I request that I be allowed into the Pretrial Drug Education and Community Service Program
under section 54-56i of the Connecticut General Statutes.
Signed (Defendant)
Date signed
I have read the above
Consented to by (Parent or Guardian)
information and understand it.
Signed (Duly authorized person)
Print name
Date signed
(Page 1 of 2)
Print Form
Reset Form
Order of the Court
("X" All that apply)
The application is denied.
The application is granted. The court orders the court filed sealed as to the public, refers the defendant to CSSD for confirmation of the
defendant's eligibility, and:
As this is the first or second time that the defendant's application has been granted, the defendant is referred to DMHAS for
evaluation and determination of an appropriate drug education or substance abuse treatment program.
As the defendant is a veteran, and as this is the first or second time that the defendant's application has been granted, the
defendant is referred for evaluation and determination of an appropriate drug education or substance abuse treatment program to:
DMHAS
Connecticut Department of Veterans Affairs
United States Department of Veterans Affairs
As this is the third time or beyond that the defendant's application has been granted, the defendant is referred to a state-licensed
substance abuse treatment program for evaluation and determination of an appropriate substance abuse treatment program.
As the defendant is a veteran, and as this is the third time that the defendant's application has been granted, the defendant is
referred for evaluation and determination of an appropriate substance abuse treatment program to:
State-licensed substance abuse treatment program
Connecticut Department of Veterans Affairs
United States Department of Veterans Affairs
The case is continued to allow CSSD to process the filed affidavit of indigency or inability to pay.
Case continued to (Date and time)
Signed (Judge, Assistant Clerk)
Date signed
JD-CR-118 (Page 2 of 2) Rev. 10-16
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