Full Text
Columbia Judicial Circuit Felony Accountability Court Referral Form Program of Interest: ☐ Drug Court: Traditional Track (Pre-Adjudication) ☐ Drug Court: Probation Track (Post-Adjudication) ☐ Mental Wellness Treatment Court ☐ Veteran’s Treatment Court Date of Referral: Defendant’s Name Date of Birth Social Security Number - - Gender Race Referral Source/Attorney: Phone Number Physical Location of Defendant for Contact: Incarcerated ☐ County Bonded ☐ ( ) Street Address City, State Zip Code Phone Number What is the physical address where the Defendant will live, if accepted into the program? Physical Address City, State II. CURRENT CHARGES Date of Charge Pending Case Number Type of Charge III. PRIOR CHARGES Date of Charge Case Number Type of Charge I. DEFENDANT INFO ---PAGE BREAK--- 1. Does the Defendant have a mental health diagnosis? ☐ Yes ☐ No a. If so, please provide proof of diagnosis from treating doctor or facility (mental health records will be requested, if client is found eligible) 2. Has the Defendant ever been hospitalized for mental health and/or substance use disorder? ☐ Yes ☐ No a. If so, please provide proof of services from the facility (additional records will be requested, if client is found eligible) 3. Is this a transfer case request? ☐ Yes ☐ No a. If yes, please include the entire file with the application to include the original charge and discovery. 4. Is the Defendant a Veteran? ☐ Yes ☐ No a. If so please include proof of Veteran status, i.e. DD214. For consideration, please complete and email to: E. Grace Jolly, Assistant District Attorney Email: [EMAIL REDACTED] Please also copy the following individuals: LaTeisha Mosquera, Accountability Court Program Coordinator Email: [EMAIL REDACTED] Cindy Clifton, Accountability Court Case Manager: Email: [EMAIL REDACTED] Please provide any medical records to: Franshon Hollis, Accountability Court Treatment Provider (Dr. D.W. DeVose and Associates) Email: [EMAIL REDACTED] IV. RECORDS REQUEST