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Yes
No Is the applicant's PERMANENT address in Prince George's County? |
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Yes
No Is the applicant eighteen (18) years of age or older? |
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Yes
No
Is there any indication of recent or past substance abuse? (Arrests, assessments, treatment, self-report, etc.) |
INELIGIBLE CRIMES
(Prior Convictions, Current Charge, Any Attempt, Conspiracy to Commit, or Accessory Before or After the Fact) |
| Abduction |
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Voluntary or Involuntary Manslaughter |
| Arson in the first degree |
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Maiming |
| Carjacking |
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Mayhem |
| Burglary in the first degree (Intent to commit crime of violence) |
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Murder in the first or second degree |
| Domestic Violence (within the past 5 years) |
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Rape in the first or second degree |
| Escape in the first degree |
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Robbery |
| Firearm Offense |
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Robbery with a deadly weapon |
| Kidnapping |
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Sexual offense in the first, second and third degree. |
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Yes
No Is the current charge an INELIGIBLE crime? |
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Yes
No Is the referred case a violation of probation? |
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Yes
No Are there any other or concurrent parole of probation cases (regardless of jurisdiction) ? |
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Yes
No Is the applicant currently in jail? (If Yes, since
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Yes
No Was a firearm possessed or used in the present offense? |
Yes
No Has the applicant ever been enrolled in HIDTA? If yes, did applicant successfully complete HIDTA Program ?
Yes
No
If No, Why?
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Yes
No Are there any other pending charges, violation of probation, sentencings, warrants, or detainers (regardless of jurisdiction)? |
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Yes
No What are the sentencing guidelines?
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Yes
No Has a drug court plea been accepted & scheduled for Drug Court sentencing? |
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Plea Judge:
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Plea Date:
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Drug Court Sent. Date:
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Person Completing Form:
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Phone Number:
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Fax Number :
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Date:
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