Change the background color using Inline style attribute Change the background color using Inline style attribute Referral Form Instructions to register: Courts: Complete Registration Form, and click 'Submit'. First Name Last Name Phone Emergency Phone Email Street City State/Province --None--Acre Agrigento Aguascalientes Alabama Alagoas Alaska Alberta Alessandria Amapá Amazonas Ancona Andaman and Nicobar Islands Andhra Pradesh Anhui Aosta Arezzo Arizona Arkansas Arunachal Pradesh Ascoli Piceno Assam Asti Australian Capital Territory Avellino Bahia Baja California Baja California Sur Bari Barletta-Andria-Trani Beijing Belluno Benevento Bergamo Biella Bihar Bologna Bolzano Brescia Brindisi British Columbia Cagliari California Caltanissetta Campeche Campobasso Carbonia-Iglesias Carlow Caserta Catania Catanzaro Cavan Ceará Chandigarh Chhattisgarh Chiapas Chieti Chihuahua Chinese Taipei Chongqing Clare Coahuila Colima Colorado Como Connecticut Cork Cosenza Cremona Crotone Cuneo Dadra and Nagar Haveli Daman and Diu Delaware Delhi District of Columbia Distrito Federal Donegal Dublin Durango Enna Espírito Santo Federal District Fermo Ferrara Florence Florida Foggia Forlì-Cesena Frosinone Fujian Galway Gansu Genoa Georgia Goa Goiás Gorizia Grosseto Guanajuato Guangdong Guangxi Guerrero Guizhou Gujarat Hainan Haryana Hawaii Hebei Heilongjiang Henan Hidalgo Himachal Pradesh Hong Kong Hubei Hunan Idaho Illinois Imperia Indiana Iowa Isernia Jalisco Jammu and Kashmir Jharkhand Jiangsu Jiangxi Jilin Kansas Karnataka Kentucky Kerala Kerry Kildare Kilkenny L'Aquila Lakshadweep Laois La Spezia Latina Lecce Lecco Leitrim Liaoning Limerick Livorno Lodi Longford Louisiana Louth Lucca Macao Macerata Madhya Pradesh Maharashtra Maine Manipur Manitoba Mantua Maranhão Maryland Massa and Carrara Massachusetts Matera Mato Grosso Mato Grosso do Sul Mayo Meath Medio Campidano Meghalaya Messina Mexico State Michigan Michoacán Milan Minas Gerais Minnesota Mississippi Missouri Mizoram Modena Monaghan Montana Monza and Brianza Morelos Nagaland Naples Nayarit Nebraska Nei Mongol Nevada New Brunswick Newfoundland and Labrador New Hampshire New Jersey New Mexico New South Wales New York Ningxia North Carolina North Dakota Northern Territory Northwest Territories Novara Nova Scotia Nuevo León Nunavut Nuoro Oaxaca Odisha Offaly Ogliastra Ohio Oklahoma Olbia-Tempio Ontario Oregon Oristano Padua Palermo Pará Paraíba Paraná Parma Pavia Pennsylvania Pernambuco Perugia Pesaro and Urbino Pescara Piacenza Piauí Pisa Pistoia Pordenone Potenza Prato Prince Edward Island Puducherry Puebla Punjab Qinghai Quebec Queensland Querétaro Quintana Roo Ragusa Rajasthan Ravenna Reggio Calabria Reggio Emilia Rhode Island Rieti Rimini Rio de Janeiro Rio Grande do Norte Rio Grande do Sul Rome Rondônia Roraima Roscommon Rovigo Salerno San Luis Potosí Santa Catarina São Paulo Saskatchewan Sassari Savona Sergipe Shaanxi Shandong Shanghai Shanxi Sichuan Siena Sikkim Sinaloa Sligo Sondrio Sonora South Australia South Carolina South Dakota Syracuse Tabasco Tamaulipas Tamil Nadu Taranto Tasmania Tennessee Teramo Terni Texas Tianjin Tipperary Tlaxcala Tocantins Trapani Trento Treviso Trieste Tripura Turin Udine Utah Uttarakhand Uttar Pradesh Varese Venice Veracruz Verbano-Cusio-Ossola Vercelli Vermont Verona Vibo Valentia Vicenza Victoria Virginia Viterbo Washington Waterford West Bengal Western Australia Westmeath West Virginia Wexford Wicklow Wisconsin Wyoming Xinjiang Xizang Yucatán Yukon Territories Yunnan Zacatecas Zhejiang Zip Country United States BAC Prior Charges Judge --None--Hon. Allen C. Yenior Hon. Amy Grace Gierhart Hon. Benjamin T. Bolser Hon. Eric James Hon. David Gubow Hon. Donald A. Teeple Hon. Gerald M. Prill Hon. James N. Erhart Hon. Mark E. Luoma Hon. Patricia Morse Hon. Raymond P. Voet Hon. Steward D. McDonald Hon. Thomas J. LaCross Hon. Thomas J. Phillips Hon. William Kelly Probation Officer --None-- Annette Porter Dave Maddox Gail Wait Greg Shultz Heather Crowe Jacalyn MacDonald Lisa Smith Lynne Maki Maria Shrift Melissa Sousek Michael Siemen Phil Kieliszewski Ron Morseau Samuel Whelan Sarah Benjamin Satin Vandenburg Sue Latuszek Wendy Sprinds Court --None--64-A District Court 65B District Court 81st District Court 86th District Court 87A District Court 88-2 District Court 88th District Court 90th District Court 93rd District Court Contact Type --None-- Client Participant Client Participant Camp contact Counselor Court referred client Referring court contact Vendor Attorney Case # Charge Sentencing Date MM/DD/YYYY Referral Date MM/DD/YYYY Program Dates --None--*RCWW 04/24/21-04/25/21 *RCWW 05/22/21-05/23/21 *RCWW 06/26/21-06/27/21 *RCWW 07/24/21-07/25/21 *RCWW 08/28/21-08/29/21 Program/Service Reality Check Web Weekend Reality Check Web Day Self-Defeating Behaviors Assessment Coaching - Communications Coaching - Substance Abuse Counseling - Group Counseling - NLP Hypnotherapy Device --None-- CPU/Mic/HS WIFI Phone/unlimited data/or HS WIFI Tablet/unlimited data or HS WIFI Printer Access --None--Access to printer prior to program. No access to printer prior to program.
