Assessor/Probation Officer Referral

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Date
Due in Date
Offender Name
Case #
Offender Date of Birth
Substance Related Arrest Note: Spanish speaking services are available for SRA classes	13 Classes 2 Drug Tests 6 AA/NA 26 Classes 4 Drug Tests 12 AA/NA 39 Classes 6 Drug Tests 18 AA/NA 52 Classes 8 Drug Tests 24 AA/NA
Assault Related Arrest Note: ARA is intended for Anger Management/Coping Skills, not spousal battery cases	13 Classes 2 Drug Tests 26 Classes 4 Drug Tests
Making Better Choices Note: For poor social values/impulse control issues (theft, bogus checks, shoplifting and criminal thinking)	13 Classes 2 Drug Tests 26 Classes 4 Drug Tests
Twelve Step (AA/NA) Meetings are Waived	Yes
Drug Tests are Waived	Yes
Referral Source Signature
Title	Probation Officer Assessor
Phone Number
Fax
E-mail Address
Court Jurisdiction or Probation Period expires
Specific Instructions

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