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Columbia Judicial Circuit Felony Accountability Court Programs Referral Form Accountability Courts Program Rhoda Kimble-Wheeler, Coordinator Columbia Judicial Circuit Telephone: (706) 447-6761 Fax: (706) 321-7437 Honorable James G. Blanchard, Jr. Chief Superior Court Judge (SECTION IV MUST BE ANSWERED FOR CONSIDERATION) Program of Interest: ☐ Drug Court (traditional track - nolle prossed) ☐ Behavioral Health Treatment Court ☐ Veteran’s Treatment Court Date: ☐ Probation Drug Court Track (must complete section IV – not available at this time) I. DEFENDANT INFO Defendant’s Name Date of Birth Social Security Gender Referral Source/Attorney: Phone Number Physical Location of Defendant for Contact: Incarcerated ☐ 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 ---PAGE BREAK--- IV. PROBATION TRACK QUESTIONS (not available at this time) 1. Is the District Attorney’s Office in agreement with the Defendant applying and entering the Probation Drug Court Track? ☐ Yes ☐ No 2. Has Defendant been found ineligible for Traditional Drug Court? ☐ Yes ☐ No 3. Is the presiding judge aware of your application to the Probation Drug Court Track? ☐ Yes ☐ No V. RECORDS REQUEST 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: Attention: Mr. Zachary Kafoglis, Assistant District Attorney Email: [EMAIL REDACTED] Please also copy the following individuals: Mrs. Rhoda Kimble-Wheeler, Accountability Courts Coordinator Email: [EMAIL REDACTED] Mrs. Betty Johnson, Accountability Courts Case Manager Email: [EMAIL REDACTED]