Certification and Program Forms
Starting a Program
There are approximately 55 Court Alcohol and Drug Programs within the state. A listing of these Programs is available from the Indiana Office of Court Services. These programs are governed by statute (IC 12-23-14) and by Court Alcohol and Drug Program Rules.
Court Alcohol and Drug Programs in Indiana are governed by statute (IC 12-23-14) and Judicial Conference Rules. Statutes and rules authorize the Indiana Office of Court Services to establish procedures to certify court alcohol and drug programs.
Client Demographics - Due March 31, 2018
Client Demographics Part 1 - This form is part 1 of 3 forms to enter the client demographic information for the 2017 reporting period. Please note that in section 5 you will identify which charges your program served. The felony and misdemeanor information should be entered in separate forms. There is a separate link for the Felony Charges (Part 2) and Misdemeanor Charges (Part 3), if applicable.
Client Demographics Part 2 - This form is part 2 of 3 forms to enter the client demographic felony charge information for the 2017 reporting period. Please enter your agency information and all applicable sections in this form. There are separate forms for the Client Demographics that includes sections 2-4 and 6-11 of the report (Part 1) and the Misdemeanor Charges (Part 3-if applicable).
Client Demographics Part 3 - This form is part 3 of 3 forms to enter the client demographic information for the 2017 reporting period. Please enter your agency information for Misdemeanor Charges (if applicable) There will be a separate form for sections 2-5 and 6-11 in this report (Part 1) and the Felony Charges (Part 2).
Documents and Forms
|Staff Update Form|
|Sample Criminal Justice Consent for Release of Information Form||Word|
|Sample General Consent for Release of Information Form||Word|
|Sample Response to Subpoena - Criminal||Word|
|Sample Response to Subpoena - Civil||Word|
|Sample Qualified Service Organization Agreement||Word|
|Sample Prohibition on Re-Disclosure||Word|
|Client Rights Form||Word|
|Client Signature Page||Word|
|Individual Service Contract Sample 1||Word|
|Individual Service Contract Sample 2||Word|
|Sample Client Survey||Word|
|Sample Referral Agreement||Word|