San Mateo — Application for Admission into Veterans Treatment Court

Source: https://sanmateo.courts.ca.gov/system/files/local-forms/vtc-01.pdf

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN MATEO

THE PEOPLE OF THE STATE OF CALIFORNIA Case Number(s): Plaintiff, vs.

Defendant

APPLICATION FOR ADMISSION INTO VETERANS TREATMENT COURT

1. I, ____________________________, am an Active Duty Member, or a Veteran with an Honorable or

   General Discharge, of the United States Armed Services.

2. I understand that: a. To be considered for this program, signed copies of this Application and the Consent to Release of Confidential Information forms must be delivered to: i. Service Connect Office, County of San Mateo Hall of Justice and Records, 1 st Floor, 400 County Center, Attn: Veterans Court Clinician Daniel Gunther (Fax 650-701-0277); and, ii. Adult Probation, County of San Mateo, Hall of Justice and Records, 400 County Center, 5 th Floor, Redwood City, CA, Attn: Michael Leon (Fax 650-363-4829).

b. Veterans Treatment Court involves a long-term treatment program and probation terms.
c. If admitted, I will be subject to Veterans Treatment Court rules, which may include electronic
monitoring, drug testing, and, for any rules violations, flash incarcerations.
d. Any restitution that I owe to any victim of a crime I have committed will remain due and
payable until paid, even if I complete Veterans Treatment Court.

3. My full name, address and phone number are:

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4. I am represented by: (name, address & telephone number of your attorney, if you have one)

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5. I have been convicted of the following charges (or have admitted the following Probation Violations)

in San Mateo County Superior Court Case Number indicated above:

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6. I am asking to be admitted into Veterans Treatment Court because: (if more space needed, attach

additional page):

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I, ____________________________, understand all of the above, and acknowledge that everything I have said about myself in the preceding answers is true.

Dated: ________________________________________ Veteran’s Signature Additional page attached

Form adopted for Mandatory Use APPLICATION FOR ADMISSION INTO VETERANS TREATMENT COURT Pen.Code § 1170.9 Local Court Form VTC 01 [Rev. May 2012]