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Passive GPS Active GPS RF Tether Sobrietor Alcohol Monitor MEMS 2000
Enrollment Date:
Length Of Sentence:
Enrollment Instructions:
Offender Information
Last Name
First Name
Middle
DOB
DL # or State ID #
SS#
,
Address
City, State
Zip
Home Phone
Cell Phone
Pager
Height
Weight
Sex
Race
Eye Color
Hair Color
Scars/Marks/Tattoos:
Language/Interpreter:
Emergency Contact Information
Relationship to Offender
Work/Pager
Victim Information
Court Information
Docket #
Referring Court
Referring Judge/Magistrate
Charge(s)
Probation Officer
PO Phone #
PO Email Address
INBOUND (Places offender must be during a certain time)
Location: HOME
Radius: (Please put feet / miles / etc.) Grace Period: (Please put minutes / etc.)
Comments/Schedule (Including Work/School Schedule):
Offender’s Work Location:
Cross Streets
Offenders School Location:
Victim Location:
Message to Appear to OFFENDER upon entering this range
Victim Work Location:
Victim School Location:
Please be sure to look at all of the above information.
If all information above is complete and correct, please enter 4683 in the box at right:
Please only click on submit once, it may take a few minutes to process the form. Thank you.