Fayette County Teen Court Referral
Located in Fayette County, West Virginia, our Teen Court program provides alternative sentencing options for youth offenders from grades 7th to 12th. This form is to be used when referring Juvenile Offenders to participate in the program as opposed to the traditional juvenile system or traditional school disciplinary procedures.  

The highest offense referred to Teen Court would be a misdemeanor including shoplifting, vandalism, traffic violations, or minors in possession of tobacco and/or alcohol. We can also accept offense lower than misdemeanors including truancy and harassment/bullying. 

If you have any questions, comments or concerns regarding this form or the Teen Court Program, please contact Diane Callison at fayettefrn@gmail.com or 304-575-1428
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Referrer First Name *
Referrer Last Name *
Referrer Phone *
Referrer Email *
Referrer Address (address, city, state, zip)
Youth First Name *
Youth Last Name *
Youth's School
Student Grade *
Youth Gender *
Youth Date of Birth
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DD
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Parent/Guardian Name *
Parent/Guardian Phone *
Parent/Guardian Email
Parent/Guardian Address (address, city, state, zip)
Is the parent/guardian aware the juvenile is being referred to Teen Court?
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Offense Information
Please email any citations or other reports to fayettefrn@gmail.com. Include any witness and/or victim statements.
Offense *
Date of Offense *
MM
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DD
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Comments/Explanation of events *
Are you willing to answer questions from the youth attorneys at a Teen Court Hearing? *
Was there another adult (ie. teacher, administration, police officer, etc.) directly involved in the offense? *
If yes, please provide the name and phone number of that individual. 
Victim Information (if any)
Victim First Name
Victim Last Name
Victim Date of Birth
MM
/
DD
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YYYY
Victim Phone
Victim Email
Victim Parent/Guardian Name
Victim Parent/Guardian Phone
Victim Parent/Guardian Email
Victim Address (address, city, state, zip)
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