Juvenile Diversion - Parent Form
For any juvenile cited by law enforcement or over 20 days absent from school, the Otoe County Attorney's Office would like certain information from such youth and his/her parent/guardian before proceeding with any juvenile court prosecution or juvenile diversion program. Please complete the following screen and survey within 48 hours. If you should have any questions or difficulty completing this form, please contact
(402) 969-0319 or email vsherman@otoecountyne.gov.
*Upon review you will receive an email confirmation or call regarding your child's program eligibility and next steps*
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Name *
Child Name (a separate form must be completed for each child given a citation) *
Today's date *
MM
/
DD
/
YYYY
Email *
Phone number *
Gender of Child *
Race/Ethnicity of Child *
What is your relationship to the child? *
How many live in the household? *
List the offense(s) your child was cited for *
List any prior offenses (indicate "none" if no prior law violations) *
List any prior diversion or probation services your child has received? (indicate "none" if your child has received no other services) *
What discipline/consequences at home have already taken place due to this incident? *
Has he/she ever been suspended/expelled from school in the last 3 months? *
Has he/she skipped school in the last 3 months? *
Is he/she involved in extra-curricular activities? *
Is he/she employed? *
Are you concerned with your son/daughter's friend choices? *
Was he/she intoxicated at the time of this offense? *
Has he/she tried/used cigarettes, chewing tobacco, or nicotine vape products in the last 3 months? *
Has he/she consumed alcohol in the last 3 months *
Has he/she used marijuana or THC products in the last 3 months? *
Has your child ever been physically violent to you or others? *
Has your child completed any type of community service or volunteered in the past? *
Does your child receive any type of service in or outside the home (counseling/therapy, tutoring, special education, etc.) Pleas list services he/she receives. *
Would you or your child like to receive additional services and/or information helpful to your family and what types if interested: (Housing, food, school supplies, mentoring, counseling, etc.) *
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