When an individual is placed on probation, there are terms and conditions that must be met in order to remain off of probation. If the individual does not meet these terms, then the probation officer has the authority to transfer the person to a higher level of supervision. The Probation Transfer Request Form is used by the probation officer to request a transfer from one level of supervision to another. The form can be used for adult or juvenile offenders, and must be approved by a supervisor before it is submitted to a court. The form includes information about why the transfer is needed, as well as contact information for the offender and his or her attorney.
These are some details about probation transfer request. You might want to study it just before submitting the form.
| Question | Answer |
|---|---|
| Form Name | Probation Transfer Request |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | interstate compact application, probation transfer application, probation transfer form, indiana intrastate probation |
INDIANA INTRASTATE PROBATION TRANSFER REQUEST
To: _________________________ From: _________________________ Date: _________________
(Receiving Court Probation Dept.)(Sentencing Court Probation Dept.)
Offender’s name: _______________________________ Case No.: ____________________________
Race: ___________ Gender: __________ D.O.B.: ___________ SSN: ________________
Sex offender: Yes
No
DNA Sample Collected: Yes
No
Sex offender registration required: Yes
No
Offense(s): _________________________________________________________________________
(Please do not use abbreviations; specify “count I,” “count II,” etc.)
Date convicted: ___________________________ |
Date probation began: _____________________ |
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Probation period: __________________________ |
Date probation expires: ____________________ |
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Offender currently on probation under another case number: Yes |
No |
; if “yes”, please provide |
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whether the other term runs concurrently or consecutively, and whether the offender is in compliance with the terms of probation: ____________________________________________________________
Offender current on probation/program fees: Yes
No
Restitution (amount owed, schedule of payments): _________________________________________
Residence: _________________________________________________________________________
(Street Address)(City)
_________________________________________ Telephone: ______________________
(State) |
(Zip) |
Employment: ________________________________________________________________________
(Employer Name)(Street Address)
__________________________________________________ Telephone: _______________
(City) |
(State) |
(Zip) |
Reason for transfer:
Offender lives in receiving county (mandatory)
Offender works in the receiving county (discretionary)
Offender is taking educational courses in the receiving county (discretionary)
Offender has other significant contacts/relatives in the receiving county (discretionary)
(please explain: ______________________________________________________________)
Additional Programs/Services Requested: (Check all that apply)
Complete a Certified Court Administered Alcohol & Drug Program
Individual Service Contract attached (including criminal justice consent)
Referred Services (ie, anger management, alcohol education, Thinking for a Change):
Mental Health treatment
Other (please specify):
Special Conditions of Probation or Comments:
THE FOLLOWING MATERIALS MUST BE INCLUDED WITH THIS REQUEST FORM: sentencing order; conditions of probation; payment agreement/deadlines; PSI/criminal history; risk and needs assessments; substance use evaluation (if applicable); A&D individual service contract (if applicable); sex offender conditions (if applicable); plea agreement (if applicable). Include additional information as needed.
Please include a photograph of the offender if available.
BY: _______________________________________ |
____________________________________ |
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(Probation Officer) |
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(Department Address) |
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Telephone: ______________________________ |
____________________________________ |
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(City) |
(Zip) |
Fax: ________________ |
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