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Proof of Enrollment and Completion of Alcohol and Drug Program Mobile App

The Proof of Enrollment or Completion in a Drug and Alcohol Program form is a court form that provides for proof that a defendant has enrolled in a substance abuse program, or that such a program has been completed. Defendants that have been convicted or charged with crimes related to drug abuse, alcohol abuse, or the use of illicit drugs, typically enroll in an educational or treatment program as a part of a jail diversion strategy, or for successful completion of probation. This form covers both the enrollment and completion of such a program.

  • Lendlease
  • The Cooperative
  • PG&E
  • Toys R Us
  • Red Bull
  • Mirvac

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Take a peek inside the Proof of Enrollment and Completion of Alcohol and Drug Program Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    Instructions: (1) Upon enrollment in a court-ordered alcohol or drug education program, fill out...

  • Ico textbox

    Court Name

  • Ico textbox

    Court Address

  • Ico textbox

    Court City

  • Ico dropdown

    Court State

  • Ico textbox

    Defendant Name

  • Ico textbox

    Defendant Street Address

  • Ico textbox

    Defendant Mailing Address

  • Ico textbox

    Defendant City

  • Ico dropdown

    Defendant State

  • Ico textbox

    Defendant Zip

  • Ico dropdown

    Enrollment or Completion?

  • Ico textbox

    Case Number:

  • Ico textbox

    Name of Program:

  • Ico textbox

    Address of Program

  • Ico textbox

    City of Program

  • Ico dropdown

    State of Program

  • Ico textbox

    Zip of Program

  • Ico textbox

    Program License Number

  • Ico textbox

    Program Phone Number

  • Ico textbox

    Name of Program:

  • Ico date

    Enrollment Date:

  • Ico statictext

    The Defendant is enrolled in the alcohol or drug education program described above, and has been ...

  • Ico statictext

  • Ico statictext

    I declare under penalty of perjury that the foregoing is true and correct.

  • Ico signature

    Defendant Signature

  • Ico date

    Date Signed

  • Ico textbox

    Defendant Name

  • ...and More!

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