Offender's Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth* Date Format: MM slash DD slash YYYY Probation Expiration Date* Date Format: MM slash DD slash YYYY Case Number*Phone*Is Offender Currently on Probation?*YesNo(If currently on probation, add probation expiration date)Does the offender have any pending charges in this or any other jurisdiction*YesNo(If there are pending charges, which jurisdiction, when, and what is(are) the charge(s)?)Is the offender a resident of Arlington County, VA?*YesNoIs the offender on probation supervision or on supervision involving Interstate Compact for a jurisdiction other than Arlington County, VA?*YesNoDoes the offender have any prior felony convictions for a violent offense, i.e., felony or sexual assault, robbery and/or weapons offenses(s) in the past 10 years?*YesNoDoes the offender have any pending charges, which have the potential for a jail sentence?*YesNoList charge, jurisdiction and court date(s):Other Information:Based on the information provided, the offender is not eligible.If you have any questions, contact Drug Court Administrator Cliff Jacobs or call 703-228-7160.Referring AttorneyName* First Last Email* Phone*NameThis field is for validation purposes and should be left unchanged.