Get Referral / Application Form - Courts State Nh

Filling out the Referral / Application Form for the Courts State of New Hampshire can seem challenging, but with clear guidance, you can complete it smoothly. This guide provides step-by-step instructions tailored to users with varying levels of experience in legal documentation.

Follow the steps to successfully fill out the form online.

1. Press the ‘Get Form’ button to access the Referral / Application Form. This will allow you to open the document in your preferred editing tool.
2. In the 'Referral Source' section, write the name of the person or agency providing the referral. Fill in the 'Date of Referral' to indicate when this application is being submitted.
3. Complete the 'Agency' section with the name and contact details of the agency involved in the referral. Include a valid phone number and email address.
4. Fill in the 'Client Information' section with details about the individual applying, including their name, any maiden names or aliases, date of birth, age, race, and gender.
5. Indicate if the client is currently in custody by marking 'Y' for yes or 'N' for no and note their location if applicable.
6. Provide the client's Social Security number and confirm their U.S. citizenship status. If not a citizen, specify their citizenship.
7. Document the client's primary language and any current situation, such as being incarcerated or on probation.
8. Fill in contact information such as home, work, and cell phone numbers. Additionally, provide details for an emergency contact including their relationship to the client.
9. Address the questions regarding legal guardianship, Social Security benefits, and any additional financial support or benefits received.
10. Complete the 'Family and Relationships' section by identifying supportive people in the client's life and detailing their marital status and children.
11. Answer questions related to residence, criminal history, education, military service, employment status, and medical background.
12. Address the mental health and substance use sections truthfully, detailing any previous treatments or diagnoses.
13. In the Mental Health Court Goals section, reflect on any desired changes and articulate why acceptance to the Mental Health Court is being sought.
14. Review the application for accuracy. Finally, add your signature, date it, and include signatures from any guardians or witnesses if applicable.
15. After completing all sections, you can save your changes, download the form, print it, or share it as needed.

Complete the Referral / Application Form online to ensure a smooth process in accessing mental health court services.