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Get Proof Of Enrollment Or Completion Form

UPON ENROLLMENT IN A COURT-ORDERED ALCOHOL OR DRUG EDUCATION PROGRAM FILL OUT THE PROOF OF ENROLLMENT PORTION OF ONE COPY OF THIS FORM AND FURNISH IT TO THE SENTENCING COURT WITHIN THE TIME AND IN THE MANNER SPECIFIED BY THE COURT. 2. UPON SUCCESSFUL COMPLETION OF THE PROGRAM FILL OUT THE PROOF OF COMPLETION PORTION OF A SECOND COPY OF THIS FORM AND FURNISH IT TO THE SENTENCING COURT WITHIN THE TIME AND IN THE MANNER SPECIFIED BY THE COURT. FOR COURT USE ONLY NAME AND ADDRESS OF COURT To keep other people from seeing what you entered on your form please press the Clear This Form button at the end of the form when finished. NAME OF DEFENDANT STREET ADDRESS MAILING ADDRESS CITY AND ZIP CODE DATE OF COURT ORDER check one PROOF OF ENROLLMENT IN ALCOHOL OR DRUG PROGRAM CASE NUMBER PROOF OF COMPLETION OF ALCOHOL OR DRUG PROGRAM DESCRIPTION OF ALCOHOL OR DRUG PROGRAM Name of Program Address of Program Program License Number Program Telephone Number enrolled in the alcohol or drug 1. Defendant name education program described above on specify date of enrollment I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date. TYPE OR PRINT NAME SIGNATURE OF DEFENDANT SIGNATURE OF PROGRAM DIRECTOR OR INSTRUCTOR TITLE successfully completed the alcohol or drug INSTRUCTIONS YOU NEED TWO OF THESE FORMS 1. UPON ENROLLMENT IN A COURT-ORDERED ALCOHOL OR DRUG EDUCATION PROGRAM FILL OUT THE PROOF OF ENROLLMENT PORTION OF ONE COPY OF THIS FORM AND FURNISH IT TO THE SENTENCING COURT WITHIN THE TIME AND IN THE MANNER SPECIFIED BY THE COURT. 2. UPON SUCCESSFUL COMPLETION OF THE PROGRAM FILL OUT THE PROOF OF COMPLETION PORTION OF A SECOND COPY OF THIS FORM AND FURNISH IT TO THE SENTENCING COURT WITHIN THE TIME AND IN THE MANNER SPECIFIED BY THE COURT. FAILURE TO COMPLY WITH THESE REQUIREMENTS MAY RESULT IN THE REVOCATION OF YOUR PROBATION* Sl USTED NO CUMPLE CON ESTOS REQUISITOS SU INCUMPLIMIENTO PUEDE RESULTAR EN LA REVOCACION DE SU LIBERTAD CONDICIONAL* Form Approved by the Judicial Council of California MC-400 Rev* January 1 1986 ALCOHOL OR DRUG PROGRAM For your protection and privacy please press the Clear This Form button after you have printed the form* Save This Form Veh. Defendant name education program described above on specify date of enrollment I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date. TYPE OR PRINT NAME SIGNATURE OF DEFENDANT SIGNATURE OF PROGRAM DIRECTOR OR INSTRUCTOR TITLE successfully completed the alcohol or drug INSTRUCTIONS YOU NEED TWO OF THESE FORMS 1. Date. TYPE OR PRINT NAME SIGNATURE OF DEFENDANT SIGNATURE OF PROGRAM DIRECTOR OR INSTRUCTOR TITLE successfully completed the alcohol or drug INSTRUCTIONS YOU NEED TWO OF THESE FORMS 1. UPON ENROLLMENT IN A COURT-ORDERED ALCOHOL OR DRUG EDUCATION PROGRAM FILL OUT THE PROOF OF ENROLLMENT PORTION OF ONE COPY OF THIS FORM AND FURNISH IT TO THE SENTENCING COURT WITHIN THE TIME AND IN THE MANNER SPECIFIED BY THE COURT.

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