Form JD-CR-154 "Application for Supervised Diversionary Program" - Connecticut

What Is Form JD-CR-154?

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 July 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-154 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-154 "Application for Supervised Diversionary Program" - Connecticut

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STATE OF CONNECTICUT
APPLICATION FOR SUPERVISED
SUPERIOR COURT
DIVERSIONARY PROGRAM
JUDICIAL BRANCH
JD-CR-154
Rev. 7-16
www.jud.ct.gov
C.G.S. § 54-56l; P.A. 16-167 § 46
Instructions to defendant:
ADA Notice
1. Fill out the Application and Military Status sections and sign this form.
2. Give the original to the clerk of the court.
The Judicial Branch of the State of Connecticut
3. Send a copy to the prosecuting attorney (the State's Attorney) for your case.
complies with the Americans with Disabilities Act
4. Keep a copy for your records.
(ADA). If you need a reasonable accommodation in
accordance with the ADA, contact a court clerk or an
Notice to Clerk: Seal file on order of the court per C.G.S. § 54-56l(c).
ADA contact person listed at www.jud.ct.gov/ADA.
TO: The Superior Court of the State of Connecticut
Docket number
Address of court
GA/JD
number
Name of defendant
Address of defendant (Number, street, apartment number, town, and zip code)
Alias/Maiden name of defendant
Telephone number of defendant
CMIS case number
Offense(s) charged
Application
I am charged with the offense(s) listed above, which are crime(s) or motor vehicle violation(s) that are not serious in nature, but could result
in a jail sentence. (“X” all that apply.)
I have a psychiatric disability and my mental or emotional condition is not caused only by substance abuse. Without care and
treatment, my mental or emotional condition has substantial adverse effects on (strongly interferes with) my ability to function.
I am a veteran and I have a mental health condition that is amenable to treatment (can be treated). I have been discharged or
released under conditions other than dishonorable from active service in the armed forces as defined in section 27-103 of the
Connecticut General Statutes.
I am applying for the Supervised Diversionary Program. If my application is granted, and I am allowed into the program, I agree to the
following:
1. To give the state more time to prosecute me (the tolling of the statute of limitations and the waiver of the right to a speedy trial)
for the offense(s) listed above if I do not successfully finish the Supervised Diversionary Program.
2. To any condition(s) that may be required 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 also understand that I cannot take part in the Supervised Diversionary Program if:
1. I am not eligible for the Accelerated Pretrial Rehabilitation Program under section 54-56e (c) of the Connecticut General
Statutes, unless I am not eligible for that Program because I am eligible for the Family Violence Education Program under
section 46b-38c instead, and the court finds that the Supervised Diversionary Program is better for me than the Family Violence
Education Program under the circumstances of my case.
2. I have used the Supervised Diversionary Program twice before.
I also understand that:
1. The court will send notice (tell) any victim of the offense(s) listed above that I have applied for the Supervised Diversionary
Program, and that the victim can tell the court whether he or she thinks I should be allowed to take part in this Program.
2. CSSD will confirm my eligibility for this program, get an assessment of my mental health condition, and find out if the right
supervision, treatment, and services options are available for me. If so, CSSD will make a treatment plan for me, and give that
treatment plan to the court.
3. If my application is granted, and I am allowed into the Supervised Diversionary Program, the court will refer me to CSSD, which
may work with the Department of Mental Health and Addiction Services, the Connecticut Department of Veterans Affairs, or the
United States Department of Veterans Affairs, where appropriate, to give me the right supervision, treatment, and services. A
probation officer who has a reduced (smaller) caseload and specialized training in working with people who have psychiatric
disabilities will supervise me.
4. Information about me and why I took part in the Supervised Diversionary Program will be available to State and local police
officers for five years after I am allowed into the Program, even though the charge(s) for the offense(s) listed above will be
dismissed if I successfully complete the Program.
5. Details of my mental or emotional condition or substance abuse issues may be made known to the court, and may become part
of my court file.
I give my permission to CSSD to get information about whether I have used the Supervised Diversionary Program before and whether I am
eligible for the Accelerated Pretrial Rehabilitation Program.
Continued on next page...
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STATE OF CONNECTICUT
APPLICATION FOR SUPERVISED
SUPERIOR COURT
DIVERSIONARY PROGRAM
JUDICIAL BRANCH
JD-CR-154
Rev. 7-16
www.jud.ct.gov
C.G.S. § 54-56l; P.A. 16-167 § 46
Instructions to defendant:
ADA Notice
1. Fill out the Application and Military Status sections and sign this form.
2. Give the original to the clerk of the court.
The Judicial Branch of the State of Connecticut
3. Send a copy to the prosecuting attorney (the State's Attorney) for your case.
complies with the Americans with Disabilities Act
4. Keep a copy for your records.
(ADA). If you need a reasonable accommodation in
accordance with the ADA, contact a court clerk or an
Notice to Clerk: Seal file on order of the court per C.G.S. § 54-56l(c).
ADA contact person listed at www.jud.ct.gov/ADA.
TO: The Superior Court of the State of Connecticut
Docket number
Address of court
GA/JD
number
Name of defendant
Address of defendant (Number, street, apartment number, town, and zip code)
Alias/Maiden name of defendant
Telephone number of defendant
CMIS case number
Offense(s) charged
Application
I am charged with the offense(s) listed above, which are crime(s) or motor vehicle violation(s) that are not serious in nature, but could result
in a jail sentence. (“X” all that apply.)
I have a psychiatric disability and my mental or emotional condition is not caused only by substance abuse. Without care and
treatment, my mental or emotional condition has substantial adverse effects on (strongly interferes with) my ability to function.
I am a veteran and I have a mental health condition that is amenable to treatment (can be treated). I have been discharged or
released under conditions other than dishonorable from active service in the armed forces as defined in section 27-103 of the
Connecticut General Statutes.
I am applying for the Supervised Diversionary Program. If my application is granted, and I am allowed into the program, I agree to the
following:
1. To give the state more time to prosecute me (the tolling of the statute of limitations and the waiver of the right to a speedy trial)
for the offense(s) listed above if I do not successfully finish the Supervised Diversionary Program.
2. To any condition(s) that may be required 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 also understand that I cannot take part in the Supervised Diversionary Program if:
1. I am not eligible for the Accelerated Pretrial Rehabilitation Program under section 54-56e (c) of the Connecticut General
Statutes, unless I am not eligible for that Program because I am eligible for the Family Violence Education Program under
section 46b-38c instead, and the court finds that the Supervised Diversionary Program is better for me than the Family Violence
Education Program under the circumstances of my case.
2. I have used the Supervised Diversionary Program twice before.
I also understand that:
1. The court will send notice (tell) any victim of the offense(s) listed above that I have applied for the Supervised Diversionary
Program, and that the victim can tell the court whether he or she thinks I should be allowed to take part in this Program.
2. CSSD will confirm my eligibility for this program, get an assessment of my mental health condition, and find out if the right
supervision, treatment, and services options are available for me. If so, CSSD will make a treatment plan for me, and give that
treatment plan to the court.
3. If my application is granted, and I am allowed into the Supervised Diversionary Program, the court will refer me to CSSD, which
may work with the Department of Mental Health and Addiction Services, the Connecticut Department of Veterans Affairs, or the
United States Department of Veterans Affairs, where appropriate, to give me the right supervision, treatment, and services. A
probation officer who has a reduced (smaller) caseload and specialized training in working with people who have psychiatric
disabilities will supervise me.
4. Information about me and why I took part in the Supervised Diversionary Program will be available to State and local police
officers for five years after I am allowed into the Program, even though the charge(s) for the offense(s) listed above will be
dismissed if I successfully complete the Program.
5. Details of my mental or emotional condition or substance abuse issues may be made known to the court, and may become part
of my court file.
I give my permission to CSSD to get information about whether I have used the Supervised Diversionary Program before and whether I am
eligible for the Accelerated Pretrial Rehabilitation Program.
Continued on next page...
Page 1 of 2
Print Form
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Military Status
Have you ever served in the U.S. Armed Forces, including the Connecticut National Guard
(as defined in section 27-103 of the Connecticut General Statutes)?
Yes
No
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.
By signing this form, I am saying that I understand all of the information included on this form, and I request that I be allowed into
the Supervised Diversionary Program under section 54-56l 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
Oath
The defendant 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 section 54-56l of the Connecticut General Statutes
more than once.
Date signed
Signed (Assistant Clerk/Duly authorized person)
Print name
First Order of the Court
("X" all that apply)
(If the application is denied and the file ordered unsealed, consider ordering the defendant's telephone number redacted.)
The application is denied.
The defendant's oath under section 54-56l(c) of the Connecticut General Statutes was taken:
in open court
outside of court by a person designated by the clerk and duly authorized to administer oaths
The application is granted. The court orders the court file sealed as to the public and refers the defendant to CSSD for confirmation of
eligibility and assessment of the defendant's mental health condition. The State's Attorney shall provide CSSD with a copy of the police
report.
at
The case is continued until
a.m./p.m.
(date)
(time)
Print name
Date signed
Signed (Judge, Assistant Clerk)
JD-CR-154 Rev. 7-16
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