Notification of Arrests, Criminal Charges, Traffic Citations, or Child Abuse Complaints
Use this form to notify the program of any arrests, criminal charges, traffic citations, or child abuse complaints. You are required to report this information to the program within 5 business days of occurrence.
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Email *
Member Name *
Date of This Report *
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Type of Notification *
Date when the above incident happened *
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Describe the nature and current status of the charge, arrest or complaint.  Also provide any information you may have about future court dates and/or disposition proceedings. *
A copy of your responses will be emailed to the address you provided.
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