*
Required Information
*
Court Appearance Date
(Date referred by court)
mm-dd-yy (example: 06-13-08)
*
Court Case Number
*
Full Name
*
Age
*
Date of Birth
mm-dd-yy (example: 06-13-08)
*
Email
*
Current Mailing Address
*
City
*
State
*
Zip Code
Permanent Address
same as mailing address
City
State
Zip Code
*
Home Phone
*
Cell Number
*
Referring Agency
(if other than Santa Barbara Superior Court)
Select
Santa Barbara Superior Court
Lompoc Superior Court
Santa Barbara Juvenile Probation
Other
*
Judges Name
*
Offense
(What you got cited or ticketed for)
*
Return Court Date
mm-dd-yy (example: 06-13-08)
*
Department Number
*
Time
*
For 1 DAY INTENSIVE Select Wednesday or Saturday:
Select
Wednesday
Saturday
Please refer to court papers for specific information.
Dates of school break
(intended only for those doing the program in Santa Barbara area)
Out of County Registration Please indicate where:
Select
Santa Barbara County
Contra Costa County
San Diego
SF/Bay Area
San Luis Obispo
Other
If other is chosen, please indicate where
Questions