Get Pti Intake Information Form

Completing the PTI Intake Information Form online is a crucial step in accessing the Pretrial Intervention program. This guide provides clear and supportive instructions to help you navigate each section of the form with confidence.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the form and open it in your editor.
2. Enter your last name, first name, and middle name accurately in the designated fields. If applicable, include 'JR' or 'III'.
3. Fill in your social security number in the appropriate format, ensuring accuracy.
4. Provide your cell phone number, including the area code, in the designated section.
5. Complete your address, including street, apartment number, city, state, and ZIP code.
6. If you have a maiden name or nickname, please include it in the specified field.
7. Indicate your race and sex in the corresponding fields.
8. Input your birthdate and state of birth.
9. Provide your driver's license number along with the issuing state.
10. Answer whether you are a US citizen and a US veteran, circling the appropriate responses.
11. If applicable, specify if you are military active or reserves, and state the approximate date of discharge.
12. If you have an attorney for the PTI charge(s), include their name and contact information.
13. Check all relevant boxes regarding your relationship status, employment status, and education.
14. List your total household income in the indicated range.
15. Describe your employment situation, including your job title, location, and length of employment.
16. Provide information about previous applications to PTI or alcohol education programs, if applicable.
17. Indicate any other pending criminal charges and provide details as necessary.
18. In your own words, describe the incident that led to the PTI application.
19. Answer questions regarding weapons involved, family awareness, and past arrests.
20. Provide information about others living in your home and describe your general health.
21. Detail your financial situation and any medications currently being taken.
22. Discuss past counseling experiences and any hospitalization for substance abuse or emotional issues.
23. Express what you hope to gain from the PTI program in the provided field.
24. Sign the application confirming the accuracy of the information provided, and include the current date.

Complete your PTI Intake Information Form online today to move forward with your application.