DUI Court Application
Program Application
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Email *
Disclosure Consent Agreement *
I understand that I am being considered as a Participant in the DeKalb County DUI Court Program and I hereby give permission to the DeKalb County State Court Probation Department to run my complete criminal and traffic history for participation approval purposes and data collection only. I also consent to the communication among the DeKalb County DUI Court Team, State Court Probation and my attorney and that they may discuss any specific information pertaining to my acceptance or denial into this program.
Required
Watch this entire video before proceeding to the application questions. The Video is approximately 13 minutes and will provide important information to assist you in making the decision to enter the program or not.  If you have trouble viewing go to this link - https://youtu.be/AmO-pnOrvZQ 
First Name *
Middle Initial *
Last Name (include Jr., Sr., etc.) *
Please list any other names used.
Date of Birth *
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Court Case Number
Gender *
Driver's License Number *
What state were you born in? *
Ethnicity *
Current Address *
# and Street
City, State and Zip *
City, ST, Zip - (You must live in DeKalb County or surrounding area to be eligible.  If you do not please contact Ms. Whaley immediately at 404-294-2509.)
At the Address Since *
Please give an approximate date that you moved to this address.
MM
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DD
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Phone # *
Please list the best phone number to contact you.
Marital Status *
Name and # of Attorney *
Name and Phone # of your Attorney.  N/A if you are not represented.
Are you currently on Probation/Parole? *
County of Probation *
If yes to prior question, please list the county where you are currently on probation. N/A if not applicable.
Have you ever participated in a DUI Court or Substance Abuse Program? *
Program Name and date? *
Name of program and the approximate date you last attended. N/A if not applicable.
Did you successfully complete the program? *
Income Status *
Date of income? *
What is the approximate date the above status started (date of hire, date of retirement or disability, etc.)?
MM
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DD
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YYYY
Name of Employer *
Please list jobs or source for all income (example Full-Time Job Name, Part-Time Job Name or Retired from Name and Part-Time Job Name). N/a if not applicable.
Annual Income Level *
Highest Education Level *
Date you last attended school? *
Date of your degree or the approximate date you last attended school.
MM
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DD
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YYYY
Military Service *
What branch of military did you serve in? *
What capacity did you serve? *
At what age did you begin to use alcohol? *
At what age did you begin to use drugs? *
Please list N/A if you have never use or tried drugs.
What is your first substance of choice? *
Alcohol, Marijuana, Cocaine, Methamphetamine, Ecstacy, etc.
What is your 2nd substance of choice? *
Alcohol, Marijuana, Cocaine, Methamphetamine, Ecstacy, etc., If none put N/A.
What is your 3rd substance of choice? *
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