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Probation Transfer Request PDF Details

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?	Yes
Fillable fields	55
Avg. time to fill out	11 min 34 sec
Other names	interstate compact application, indiana intrastate probation transfer, indiana intrastate transfer, probation transfer request

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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: _____________________
Probation period: __________________________	Date probation expires: ____________________
Offender currently on probation under another case number: Yes		No	; if “yes”, please provide

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: _______________________________________		____________________________________
(Probation Officer)		(Department Address)
Telephone: ______________________________		____________________________________
		(City)	(Zip)
Fax: ________________	E-mail: _________________________________________

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