Form CN-500 ANCH "Cina Therapeutic Court - Participant Acknowledgment of Program Requirements" - Municipality of Anchorage, Alaska

What Is Form CN-500 ANCH?

This is a legal form that was released by the Alaska Superior Court - a government authority operating within Alaska. The form may be used strictly within Municipality of Anchorage. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2018;
  • The latest edition provided by the Alaska 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 CN-500 ANCH by clicking the link below or browse more documents and templates provided by the Alaska Superior Court.

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Download Form CN-500 ANCH "Cina Therapeutic Court - Participant Acknowledgment of Program Requirements" - Municipality of Anchorage, Alaska

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IN THE SUPERIOR COURT FOR THE STATE OF ALASKA
AT ANCHORAGE
In the Matter of:
)
)
)
)
)
)
)
)
CASE NO(s).
)
Minor(s) under 18 years of age.
)
CINA THERAPEUTIC COURT -
) PARTICIPANT ACKNOWLEDGMENT
)
OF PROGRAM REQUIREMENTS
Participant(s) Name(s):
Please initial each statement to acknowledge that you understand and agree to the
program requirements of CINA Therapeutic Court (CTC):
1.
I will be honest with the court about all issues.
2.
I will abstain from alcohol, all illegal substances, and other intoxicants.
3.
I will attend, participate in, and complete treatment, therapy, educational
programs, and court ordered services.
4.
I will appear on-time in court on all scheduled court dates. If I cannot
come to court due to illness or another emergency, I will notify my attorney
no later than the morning of the court date.
5.
I understand my case will be discussed by all members of the CTC team
including the judge.
6.
I will hear confidential information during CTC sessions about other
families. This information is not to be discussed with non-CTC members.
7.
I will be drug and/or alcohol tested on a frequent basis and submit to drug
and/or alcohol testing including urine analysis (UA) and breath testing as
directed by my treatment provider, OCS case worker or by the court. If I
miss or tamper with the sample, I will be considered to test positive (dirty).
8.
If I am prescribed any prescription medications I will immediately notify my
treatment provider, OCS, and the court and provide verification of a
prescription (if applicable). If I am directed to take any over-the counter
medication that is not permitted, I will notify my treatment provider, OCS,
and the court and provide verification of the medical need for the
medication.
CN-500 ANCH (6/18)(cs)
CINA THERAPEUTIC COURT – PARICIPANT ACKNOWLEDGMENT OF PROGRAM REQUIREMENTS
IN THE SUPERIOR COURT FOR THE STATE OF ALASKA
AT ANCHORAGE
In the Matter of:
)
)
)
)
)
)
)
)
CASE NO(s).
)
Minor(s) under 18 years of age.
)
CINA THERAPEUTIC COURT -
) PARTICIPANT ACKNOWLEDGMENT
)
OF PROGRAM REQUIREMENTS
Participant(s) Name(s):
Please initial each statement to acknowledge that you understand and agree to the
program requirements of CINA Therapeutic Court (CTC):
1.
I will be honest with the court about all issues.
2.
I will abstain from alcohol, all illegal substances, and other intoxicants.
3.
I will attend, participate in, and complete treatment, therapy, educational
programs, and court ordered services.
4.
I will appear on-time in court on all scheduled court dates. If I cannot
come to court due to illness or another emergency, I will notify my attorney
no later than the morning of the court date.
5.
I understand my case will be discussed by all members of the CTC team
including the judge.
6.
I will hear confidential information during CTC sessions about other
families. This information is not to be discussed with non-CTC members.
7.
I will be drug and/or alcohol tested on a frequent basis and submit to drug
and/or alcohol testing including urine analysis (UA) and breath testing as
directed by my treatment provider, OCS case worker or by the court. If I
miss or tamper with the sample, I will be considered to test positive (dirty).
8.
If I am prescribed any prescription medications I will immediately notify my
treatment provider, OCS, and the court and provide verification of a
prescription (if applicable). If I am directed to take any over-the counter
medication that is not permitted, I will notify my treatment provider, OCS,
and the court and provide verification of the medical need for the
medication.
CN-500 ANCH (6/18)(cs)
CINA THERAPEUTIC COURT – PARICIPANT ACKNOWLEDGMENT OF PROGRAM REQUIREMENTS
9.
I understand CTC provides positive rewards for success in this program.
10.
I understand that I can be sanctioned for non-compliance with my
treatment plan, the court's requirements or any court order.
11.
I will sign all releases of confidentiality necessary for the court, including
releases that allow access to my assessment, treatment information,
medical, mental health, and behavioral health records. I understand the
court will also issue an order allowing for the exchange of information
between the treatment provider and the CTC Team members.
I have read this document and have reviewed it with my attorney. I
understand and agree to abide by the above terms of the CTC Program.
____________________________________________
______________________
Participant Signature
Date
I certify that on
a copy of this document was emailed/hand-delivered to:
AG
PD
OCS
Tribe
GAL
OPA-AJR
OPA-ASD
OPA-CLS
Clerk:
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CN-500 ANCH (6/18)(cs)
CINA THERAPEUTIC COURT – PARICIPANT ACKNOWLEDGMENT OF PROGRAM REQUIREMENTS
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