Burden to Blessing Pre-Trial Diversion Program Application

The following documents are required on all cases. Please have them signed, scanned, and ready to upload from the device you are using to complete this application:

Diversion Program Agreement
- If you have more than one offense, you will need a separate agreement for each cause number.
- Both the applicant and the attorney must sign the agreement.
Notarized sworn statement of fact
- This is a statement where you admit guilt to the charged offense; and
- You have included the type of offense, the date committed, your name, and cause number in the statement; and
- It is certified by a notary public.
- See an example of a sworn statement.
CSCD forms
- These forms are used by CSCD and help expedite the process of being admitted to the program.

Once you submit the application, a confirmation email will be sent to the listed email address for the defense attorney and any other email addresses you list at the end. Please keep a copy of the confirmation email for your records. If you do not receive a confirmation email, the application was not submitted and you will need to re-submit it.

Please add DiversionDoNotReply@CollinCountyDA.com to your address book to avoid the confirmation email going into a spam folder.

District Attorney's Burden to Blessing Pre-Trial Diversion Program Application

CASE INFORMATION

Cause Number: *

(001-12345-2020)

Add Additional Cause Number Remove

DEFENSE ATTORNEY INFORMATION

Attorney's First Name *

Attorney's Last Name *

Attorney's Phone Number *

Attorney's Email Address *

PERSONAL INFORMATION ABOUT THE DEFENDANT

Defendant's First Name *

Defendant's Middle Name

Defendant's Last Name *

Suffix (SR, JR, II, III, etc.)

Prior names, former or current aliases, etc.

Defendant's Email Address

Cell Phone Number *

Home Phone Number

Address *

City *

State * State

Zip *

Date of Birth *

Gender *

Race * Race

Ethnicity *

PEOPLE IN DEFENDANT'S HOUSEHOLD

If defendant has other people living in their household, fill out this section. If not, proceed to the next section.

First Name

Last Name

Relationship to Defendant Relationship to Defendant

Phone

Add another household member Remove

EDUCATION AND EMPLOYMENT

What is your educational status? *

If not in school, highest level of education completed?

What is your employment status?

Annual Income

What type of support can we provide you?

Help finding a job.

Help finding a mentor.

Help managing finances.

Counseling

Help getting a GED.

I do not need help at this time.

OtherOther

PRIOR POLICE CONTACT

List all incidents in which you were cited, arrested, accused or charged with a crime other than a traffic violation. Include incidents that were set aside, referred to pre-trial diversion or pardoned. (Provide full explanation including incident date, location, police agency, and disposition.)

Are you currently on community supervision (probation)? *

If yes, provide details.

Have you been on community supervision before? *

If yes, provide details.

Have you been in a pre-trial diversion program before? *

If yes, provide details.

Have you ever come in contact with law enforcement as a juvenile? *

If yes, provide details.

Besides this arrest, have you had contact with law enforcement as an adult? *

If yes, provide details.

Have you ever been granted deferred adjudication, been on probation or been convicted for any offense? *

If yes, provide details.

DEFENDANT'S PERSONAL STATEMENT

Tell us about yourself outside of this incident. Tell us why you should be accepted into the Burden to Blessing program. How would the program help you? What have you learned from this incident? *

APPLICATION DOCUMENTS

The following documents are required on ALL cases: agreement, CSCD forms, and sworn statement. You must upload a separate agreement for each cause number.

Signed Agreement (3 pages) *

Maximum upload size: 516MB

Signed CSCD Forms (3 pages) *

Maximum upload size: 516MB

Notarized Sworn Statement *

Maximum upload size: 516MB

Optional Document(s)

Maximum upload size: 516MB

EMAIL CONFIRMATION

Upon successful submission of this application, the defense attorney will receive an email confirmation. Please add DiversionDoNotReply@CollinCountyDA.com to your address book to avoid the email confirmation going into a spam folder.

Other email addresses you want confirmation sent to:

CERTIFICATION

I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the foregoing statements and answers to questions. I understand that any omission or false statements on this application shall be sufficient cause for denial of admittance into the Collin County's Pre-Trial Diversion Program.

Defendant's Signature *

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