Forsyth County DUI Court State Court of Forsyth County DUI COURT ENTRY PROCEDURE

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1 Forsyth County DUI Court State Court of Forsyth County T. Russell McClelland Jennifer O Kelley DUI Court Judge Coordinator DUI COURT ENTRY PROCEDURE 1. Defendants who are interested in DUI Court should have their attorneys discuss the program with the prosecutor assigned to the case. 2. If the defendant, defense attorney, and assigned prosecutor agree that DUI Court is appropriate for the defendant, the assigned prosecutor will review the defendant s file and determine initial eligibility (i.e. resident within 25 miles of Cumming, GA, 2 nd DUI in seven years or 3 rd or more lifetime, etc.). 3. If the defendant meets the basic eligibility requirements, the assigned prosecutor, the defense attorney, and the defendant will sign the DUI Court Referral (provided by prosecutor) and present the Order to Transfer to the assigned Judge. 4. If the assigned Judge agrees that DUI Court would be appropriate for the defendant, the assigned Judge will sign the top portion of an Order for Transfer to the DUI Court Judge for DUI Court entry. The prosecutor, defense attorney, and defendant shall sign the order where indicated. 5. The defense attorney will then obtain a DUI Court Plea in Packet from the DUI Court office, Solicitor-General s Office, or download from the DUI Court website ( 6. The defense attorney will then return all completed forms in the Plea In Packet to the DUI Court Office. Incomplete applications will not be processed, and the defendant will not be assessed for program eligibility until all required documents are submitted, including the transfer order discussed in Paragraph 4 above. 7. When the completed Plea In Packet is submitted, an appointment will be scheduled for the initial assessment. 8. After the defendant has been assessed by DUI Court staff, the defendant will be given a date to appear for DUI Court. 9. Immediately prior to DUI Court, the DUI Court Team will review all the information gathered during the application process (assessment, completed forms, etc.) and determine whether to accept the defendant into the program. 10. The defendant will be informed of the DUI Court Team s decision during the DUI Court session. If the defendant is not accepted into the program, the case will remain pending before the initial assigned Judge, and all hearings/trial dates will remain as scheduled. 11. If the defendant is accepted into the program, the defendant will be given a date and time certain to appear, with his or her attorney, for a plea before Judge T. Russell McClelland, III. 12. Prior to taking the plea, Judge McClelland will sign the bottom half of the Order for Transfer for DUI Court Entry, completing the transfer of the case. 13. After the DUI Court entry plea is taken, the DUI Court Office will schedule the defendant s orientation appointment. 14. Probation cases: Where a person is on probation in Forsyth State Court and is facing revocation, the same procedure will apply, except that the remaining sentence on the original DUI must have at least 24 months left on it, or the revocation plus the sentences on any new charges must carry a sentence of at least 24 months. If there is agreement that DUI Court is appropriate, all of the above shall apply, and both cases shall be transferred to the DUI Court Judge.

2 Forsyth County DUI Court State Court of Forsyth County T. Russell McClelland, III Jennifer O Kelley DUI Court Judge Coordinator DUI COURT APPLICATION PACKET Return this completed packet to the DUI Court Office 112 West Maple Street, Suite 102, Cumming, GA Incomplete applications will not be processed. Be sure to include the case number or warrant number where indicated. Copies of police/incident reports are appreciated. This packet includes: Transfer order MUST be signed by the original judge and prosecutor before packet is returned. DUI Court Participant Contract (if DUI Court entry is approved and a plea is entered, the transfer order and the participant contract will be filed with the Clerk of State Court) Participant Information form Fraternization Rules Assessment Alcohol/Drug Screen Criminal History Consent Form Consent for Disclosure of Confidential Substance Abuse Information Alcohol/Drug Screen Driving Policy Waiver of Right to Assert Specified Grounds as a Basis for Motion of Recusal Waiver of Rights Defendant Waiver After the completed packet is received, the defendant will be contacted to schedule an assessment. At the assessment, the defendant will sign a return notice to observe DUI Court. He or she will be told at that DUI Court session whether the application has been approved or rejected. Attorneys are not required to attend DUI Court but are welcome to do so.

3 Forsyth County DUI Court State Court of Forsyth County General Program Information What is DUI Court? DUI Court is a voluntary, post-conviction, treatment-based program for those who have been convicted multiple times for driving while under the influence of alcohol and/or other drugs. The DUI Court program offers enhanced supervision, counseling, and treatment to help participants function in the community with continuing support. The program lasts a minimum of 18 months; however, some participants will require more than 18 months in order to complete the program, so a sentence of at least 24 months is mandatory. To be eligible for consideration, applicants must: - be charged with their 2nd DUI in seven years or 3rd or more lifetime; - have sufficient charges to support a 24-month sentence; - be a resident within 25 miles of Cumming, GA; - be 17 years of age or older; - show an indication of alcohol/drug abuse or dependence; - have no prior convictions for violent felonies or current charges (either felony or misdemeanor) involving the use of force against another; - have no out-of-state warrants; and - have a valid immigration status with no ICE (immigration) holds. Benefits of the program include: - less jail time; - a reduction in fine(s) by one-half, conditioned upon successful completion of the program; - community service credit of 240 hours for successfully completing all phases of the program; - affordable treatment and alcohol/drug testing; - supervision in meeting license reinstatement requirements; and - support in achieving sobriety. Cost The cost of the program is $200 per month. This amount includes treatment and alcohol/drug testing. Any additional treatment (such as placement in a residential facility or halfway house) that a participant may require while in the program will be at his or her own expense. Participants who challenge positive test results will be required to pay for results that are confirmed positive by an independent lab. Court In Phases One through Two, participants attend court twice per month on Wednesdays (dates to be provided) at 2:30 pm. Phases Three and Four, participants are required to attend DUI Court sessions once monthly at 3:30 pm. Court usually lasts approximately two hours, and sessions are presided over by Judge T. Russell McClelland, the DUI Court Judge for the State Court of Forsyth County. Phases DUI Court is divided into four phases which each have a minimum duration; how long a participant is in a particular phase depends on the participant s level of compliance and readiness to progress in the program. In the higher phases, the program requirements lessen.

4 Treatment Each participant accepted into the Forsyth County DUI Court program will be required to attend treatment sessions at the DUI Court treatment facility, which is located in Forsyth County. Further information about the exact location of treatment services will be provided to applicants later in the application process. Group treatment sessions figure prominently into all phases of the program. The current group schedule is as follows: Phase Monday Tuesday Wednesday Thursday Friday 1 5-7pm pm 2 7-9pm 7-9pm :30pm 4 4-5:30pm (1 st & 3 rd ) *Group schedules are subject to change. Participants will also attend individual treatment sessions as directed by the Court based on the individualized treatment plan. Support Group Meetings In each phase, participants are required to attend three formal community based support group meetings, such as those offered by Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery, and/or other organizations. Participants are also required to find a permanent sponsor and meet with that person on a regular basis. Alcohol/Drug Testing Throughout the program, participants are randomly alcohol and drug tested at least twice per week. Participants call in to a drug test line each day to find out whether they are scheduled to test. Testing is conducted at the treatment facility between 7am and 9am seven days per week. Positive or missed tests will result in a jail sanction; repeat positive/missed tests may result in revocation and termination from the program. Employment/Educational Requirements All program participants must work full time or be in school full time. Please inquire regarding the acceptability of online courses. Those who are unemployed for any length of time while in the program must show proof that they are actively searching for a job. Community service hours may be imposed for those who do not show acceptable job search proof and/or for those who are not employed by the end of the job search grace period. The length of this grace period varies depending on the participant s ability to show that he or she is actively searching for a job. For more information, or to apply, please contact Jennifer O Kelley, DUI Court Coordinator. jaokelley@forsythco.com; Phone: (678)

5 Forsyth County DUI Court State Court of Forsyth County NOTICE REGARDING APPLICATION FOR ENTRY INTO DUI COURT To: Fax: From: Date: Re: Pages: 1 After reviewing the above-named defendant s application for DUI Court, the DUI Court team has decided to: Accept the defendant into the program. Defendant s plea must be entered on or before. Please call (770) to schedule a time and date for defendant s plea. Keep in mind that until the DUI Court plea is entered, the case remains assigned to the original Judge, and all court appearances are required unless you are excused by that Judge s office. Accept the defendant into the program with the following conditions:. Defendant s plea must be entered on or before. Please call (770) to schedule a time and date for the defendant s plea. Keep in mind that until the DUI Court plea is entered, the case remains assigned to the original Judge, and all court appearances are required unless you are excused by that Judge s office. Decline the defendant s application for entry into the program for the following reason(s): The case will remain assigned to Judge for adjudication If you have any questions, please feel free to Jennifer O Kelley at jaokelley@forsythco.com. Thank you. CC via , Judicial Administrative Assistant to Judge, Assistant Solicitor-General Erin O Mara, Assistant Solicitor-General

6 Forsyth County DUI Court State Court of Forsyth County T. Russell McClelland, III Jennifer O Kelley DUI Court Judge Coordinator DEFENDANT WAIVER I,, hereby authorize the release of such confidential information as may be necessary for the Forsyth County DUI Court program representative to determine eligibility for the DUI Court program and agree to hold you harmless and relieve and release you from all liability thereof. Defendant s Signature: Witnessed by: Attorney for Defendant Date:

7 Forsyth County DUI Court State Court of Forsyth County T. Russell McClelland, III Jennifer O Kelley DUI Court Judge Coordinator WAIVER OF RIGHT TO ASSERT SPECIFIED GROUNDS AS A BASIS FOR MOTION OF RECUSAL The defendant and his/her counsel acknowledge that, as a condition of acceptance to and/or continued participation in the Forsyth County DUI Court program: 1. The above-styled case will be assigned to the DUI Court division of State Court before the Honorable T. Russell McClelland, III; and 2. Should defendant fail to successfully complete the DUI Court program and be terminated from said program, the above-styled case will remain assigned to Judge McClelland. Understanding that this case will be assigned to Judge McClelland throughout all proceedings, until ultimate disposition of the case, irrespective of defendant s success or failure in completing the DUI Court program, the defendant hereby waives his/her right to assert as a basis for a motion to recuse the sitting judge: 1. That judge s personal involvement with the defendant during his/her participation in the DUI Court program; 2. That judge s knowledge, both personal and otherwise, of defendant s compliance or noncompliance with the requirements of the DUI Court program; or 3. That judge s decision to terminate the defendant from the DUI Court program on the basis of his/her failure to comply with such requirements. Defendant hereby freely, voluntarily, and knowingly waives the right to assert the foregoing as grounds for a motion to recuse and acknowledges that he/she does so having consulted with counsel. DEFENDANT S FULL NAME (print) DATE DEFENDANT S SIGNATURE DEFENDANT S ATTORNEY DATE

8 Forsyth County DUI Court State Court of Forsyth County T. Russell McClelland, III Jennifer O Kelley DUI Court Judge Coordinator WAIVER OF RIGHTS I,, understand that I am guaranteed by the United States and Georgia Constitutions the following rights: 1. A speedy trial; 2. Trial by jury; 3. The right to confront the witnesses against me; 4. The right not to incriminate myself or give any information that could be used against me, and that as a condition of acceptance into the DUI Court program, I expressly waive (that is, give up) those rights as a condition of becoming a participant in the program. I understand that by my participation in the program I am admitting guilt to the charge(s) against me, and the Solicitor General will not consent to a future expungement of this offense from my record. I also understand that if I am not accepted in the program, my waiver of the rights listed above will also be withdrawn. Any statements given by me as part of the DUI Court assessment process will not be used against me in the instant case. This, the day of, 20. Defendant s Full Name (print) Defendant s Signature Attorney for Defendant

9 Filed in Open Court, This day of, 20. Deputy Clerk STATE OF GEORGIA * IN THE STATE COURT OF FORSYTH COUNTY STATE OF GEORGIA VS. * CASE NUMBER: * ORDER OF TRANSFER TO JUDGE MCCLELLAND FOR DUI COURT ENTRY The undersigned hereby consents to the transfer of this case to Chief State Court Judge T. Russell McClelland, III if and when the Defendant is approved for entry into DUI Court. If the Defendant is not approved for DUI Court, the case will remain assigned to Judge Leslie Abernathy-Maddox. Until actually accepted into DUI Court, Defendant shall remain on current calendar(s). Application for DUI Court shall not delay trial except upon approval of the undersigned assigned judge. This day of, 20. JUDGE LESLIE ABERNATHY-MADDOX The Defendant having been approved for entry into DUI Court, the undersigned hereby consents to the transfer of this case to Chief Judge T. Russell McClelland, III, for adjudication of the case as part of DUI Court and for all subsequent proceedings herein. This day of, 20. Presented by: CHIEF JUDGE T. RUSSELL MCCLELLAND, III Attorney for Defendant Consented to by: Assistant Solicitor General Consented to by: Defendant Instructions for completion: The original assigned Judge shall sign the top half of the order, which indicates approval for submission of a DUI Court application. The original assigned Assistant Solicitor should sign the bottom, as should the Defendant and the Defense Attorney. This order should be submitted to the DUI Court Coordinator along with an original completed application packet. The DUI Court Judge will sign the bottom half of the order when taking the plea. The case is NOT considered transferred until the time of the plea. This order should not be filed until signed by both Judges.

10 IN THE STATE COURT OF FORSYTH COUNTY STATE OF GEORGIA STATE OF GEORGIA * DOCKET#: VS. * * DEFENDANT * ADDENDUM TO SENTENCE SPECIAL CONDITION OF PROBATION As a condition of participation in the Forsyth County DUI Court Program, I,, agree to the search of my person, property, place of residence, vehicle or personal effects at any time with or without a warrant, and with or without reasonable cause, when required to do so by a probation officer, treatment staff, DUI Court staff, and /or a law enforcement officer. The defendant must, at any time, without warning, probable cause, articulable suspicion or a search warrant, provide a sample of blood, breath, urine, saliva or other bodily substance and submit to searches of his/her residence, workplace, vehicle, containers, records, and all other locations and items when requested to do so by any law enforcement officer, probation officer or parole officer, or DUI Court Staff. Defendant Attorney for Defendant Date Date SO ORDERED on this day of, 20. Judge, State Court of Forsyth County

11 INFORMATION SHEET First Name Middle Last Preferred Name Physical Address City State Zip Code Marital Status Telephone # ( ) Cell/Alternate # ( ) Social Security # Birth date Age Race Eye Color Hair Color Height Weight Most recent Driver s License # State Highest Level of Education completed Emergency/Other Contacts: List friends or relatives in the order in which you would like them contacted if we need to reach you. Name Relationship Address Phone Number Employment Information Employer Telephone # ( ) Employer Address City State Zip Code Occupation Occupation Hours worked per week Income: $ per month/week If unemployed, source of income:

12 Other Prior violent offenses? Explain Pending Legal issues? Explain Are you a Veteran? Are you receiving V.A. benefits? Any prior substance abuse/addiction treatment? When/Which program? Have you ever been in an Accountability Court? Where & were you successful? Medications List (Include Herbal Supplements & Vitamins) Medical Conditions DO NOT WRITE BELOW THIS LINE DUI COURT OFFICE USE ONLY Sentencing Judge: Date: Attorney: Docket #: Transfer: County: BAC: /7 /10 /Life Duration of Sentence: Comments:

13 CONSENT FOR DISCLOSURE OF CONFIDENTIAL FORSYTH COUNTY DUI COURT INFORMATION I,, have read and/or had explained to me the Notice of Patients Pursuant to 42 C.F.R. Section 2.22, shown below and which is a federal regulation, regarding the disclosure of my substance abuse treatment information and hereby consent to the release of substance abuse treatment information among the following: - Forsyth County DUI Court treatment team or any person or organization that may provide me treatment or services. - Judge T. Russell McClelland or any other Judge assigned to preside over DUI Court and other employees of the court. - The Solicitor General and staff members. - The DUI Court public defenders or my own retained lawyer. - Georgia Probation Management. - Forsyth County law enforcement and Medical personnel and personnel of Cumming City Police Department. -Any physical or mental health facility. I further understand and agree that I will appear in court as required for a review of my progress, that the court is open to the public and that, therefore, others present in court may learn of my treatment and program compliance. The purpose of this consent is to permit the court and all other named parties to have the information they need to determine my initial and continued eligibility and suitability for treatment. This includes my treatment attendance, drug test results, compliance or non-compliance with program rules, prognosis and progress in accordance with the Forsyth County DUI Court criteria. I understand that this consent will remain in effect and cannot be revoked by me until (5) years from the date of a formal termination of my involvement with the Forsyth County DUI Court Program by completion of all program requirements or termination. I understand that any disclosure made is bound by Part 2 of Title 42 of the Code of Federal Regulations, which governs the confidentiality of substance abuse patient records and that recipients of this information may redisclose it only in connection with their official duties. DUI Court Participant Date Witness Date

14 Notice to Patients Pursuant to 42 C.F.R The confidentiality of alcohol and drug abuse patient records maintained by this program is protected by federal law and regulations. Generally, the program may not say to a person outside the program that a participant attends the program, or disclose any information identifying a patient as an alcohol or drug abuser unless: 1.The participant consents in writing; 2.The disclosure is allowed by a court order; or 3.This disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit or program evaluation. Violation of federal law and regulations by a program is a crime. Suspected violations may be reported to appropriate authorities in accordance with federal regulations. Federal law and regulations do not protect any information about a crime committed by a participant either at the program or against any person who works for the program or about any threat to commit such a crime. Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under state law to appropriate state or local authorities. DUI Court Participant Date Witness Date

15 CONSENT FOR THE RELEASE OF INFORMATION TO THE FORSYTH COUNTY DUI COURT PROGRAM I, consent to communication among the Forsyth County DUI Court and Treatment Providers, State, Private, or County Probation, Public Defender, Solicitor General, and other agencies regarding any and all information requested pertaining to me, to include, but not be limited to information obtained through GCIC/NCIC record checks, court records, and information concerning substance abuse, drug testing, diagnosis and treatment. I also consent to participation in open Court sessions which entails that there will be some discussion of my behavior in open Court and that citizens are allowed to be present during these sessions. I understand that this information will be public in nature, though the Judge will attempt to minimize the divulgence of personal information in this forum. I authorize any prison, detention center, county jail or city jail in which I have been confined to release to the court all information in my records concerning tests for HIV (AIDS), tuberculosis, and hepatitis. I authorize any ignition interlock provider to release to the court any and all information regarding my ignition interlock device and reports regarding said device. I release the facility and personnel which releases such information to the Court from any and all liability for complying with this authorization. The purpose of and need for the disclosure is to inform the criminal justice agency (ies) listed above of my attendance, progress, and treatment. The extent of information to be disclosed is my diagnosis, information about my attendance or lack of attendance at treatment sessions, my cooperation with the treatment program, prognosis, and drug test results. This consent will remain in effect for five (5) years from the date of final disposition of this case by either dismissal or sentencing. Any disclosure made is bound by Part 2 of Title 42 of the Code of Federal Regulations governing confidentiality of AOD abuse patient records and that recipients of this information may re-disclose it only in connection with their official duties. Signature of Participant Date Witness Date Forsyth County Docket Number:

16 Forsyth County DUI Court State Court of Forsyth County T. Russell McClelland Jennifer O Kelley DUI Court Judge Coordinator DUI COURT PARTICIPANT CONTRACT Name (print): Case Number(s): Please Initial All: 1. I understand that the validity of this contract is conditioned upon my eligibility for the DUI Court program. If at any time after the execution of this agreement and in any phase of the DUI Court program, it is discovered that I am, in fact, ineligible to participate in the program, I may be immediately terminated from the program and traditional criminal proceedings will resume. 2. I understand that if I enter this program and fail to complete it, I may be barred from future participation. 3. I understand that participation in DUI Court involves a minimum time commitment of eighteen months, which will include treatment, supervision, and aftercare. I understand that the program may take longer than eighteen months in my case due to my own treatment needs and sanctions that I may incur. 4. I understand that during the entire course of the DUI Court program, I will be required to attend court sessions and treatment sessions; submit to random alcohol and drug testing; and remain clean, sober, and lawabiding. I agree to abide by the rules and regulations imposed by the DUI Court Team. I understand that if I do not abide by these rules and regulations, I may be sanctioned or terminated from the program. 5. I give consent to the DUI Court Team to view my juvenile criminal history for the purpose of assessment only. I understand that these records cannot be used against me as an adult. 6. I will be responsible for my own transportation and will appear ON TIME for all court sessions, treatment sessions, and meetings as required. Lack of transportation is NOT an acceptable excuse to miss or be late for any DUI Court-related activity. 7. I understand that sanctions may include time in custody, increased treatment episodes, increased alcohol/drug testing, increased community service, and such other sanctions may be deemed appropriate by the DUI Court Team. I understand that such sanctions may be imposed unilaterally by the DUI Court Judge or upon the recommendation of the DUI Court Team without giving me prior notice or an opportunity to explain my actions. 8. I agree to cooperate in an assessment/evaluation for planning an individualized alcohol/drug treatment program adequate to my needs. I understand that my plan may be modified by the treatment provider or the DUI Court Team as circumstances arise, and I agree to comply with the requirements of any such modifications. 9. I understand that I must attend all scheduled treatment sessions and treatment appointments as required. If it is necessary to miss any sessions, I will get approval from DUI Court personnel IN ADVANCE. Also, I will give my Probation Officer documentation from my employer or doctor for verification. If I fail to get approval in advance and provide verification as directed by DUI Court personnel, the absence will be considered unexcused.

17 10. I agree to pay $ per month as a DUI Court fee throughout the program in addition to any Probation Supervision fees. This will cover the cost of my treatment, alcohol and drug screens, and anticipated treatment and counseling. I understand that if my treatment plan is changed or if I have additional alcohol and drug screens, I will have to pay for these over and above the DUI Court fee. After graduating from the program, I understand I may be required to pay a probation supervision fee. 11. I understand I will be tested for the presence of alcohol and drugs in my system on a random basis according to procedures established by the DUI Court Team and/or provider. I understand I will be given a location and time to report for my alcohol/drug test. I understand it is my responsibility to report to the assigned location at the time given for the test. I understand that if I am late for a test, I will be sanctioned. If I am unable to produce a urine sample within the screening window timeframe, then the test will be considered missed and positive. 12. I am to willingly submit to any and all drug and/or alcohol screening requested of me (including blood, breath, urine, sweat, hair, or other bodily substance). I understand that these screens will be random and will be monitored. I understand it is my responsibility to provide a clean, testable, unadulterated, undiluted, and valid alcohol and drug free specimen when requested to do so by any member of the DUI Court Team or Law Enforcement Officer. I stipulate as an express condition of probation that any and all drug screening records reflecting drug screening results which are properly authenticated shall be admissible at any court hearing, without the need of laying further foundation and I expressly waive any and all objections to such records, including but not limited to hearsay, chain of custody, and qualifications of experts or examiners. 13. I understand that substituting, altering, or trying in any way to change my body fluids for purposes of testing will be grounds for sanctions up to and including termination from DUI Court. 14. I understand that participating in DUI Court requires me to be drug- and alcohol-free at all times. I will not possess drugs (including marijuana) or alcohol, and I will not possess drug or alcohol paraphernalia. I will not associate with people who use or possess drugs, nor will I be present while drugs or alcohol are being used by others. 15. I understand that I will be required to find and maintain a formal support group sponsor during all phases of DUI Court and that my sponsor must regularly contact the treatment provider. I understand that failure on the part of my sponsor to make such contact may result in increased requirements or sanctions for me. 16. I will attend the court-ordered number of formal support group meetings per week and submit proof of attendance as required. 17. I agree to be alcohol/drug tested at any time by a law enforcement officer (i.e. police, sheriff, etc.), treatment provider, or DUI Court staff, or, at the request of the Court, by any agency designated by the court. 18. I understand that, for the safety of the supervision officers, I may not possess any weapons while I am in DUI Court. I will dispose of any and all weapons in my possession and will sign an affidavit certifying there are no weapons in my residence. Failure to dispose of weapons may result in a sanction or possible termination from DUI Court. I understand I may not be in a vehicle or residence where such weapons are located. 19. I agree to inform any law enforcement officer with whom I come in contact that I am in DUI Court. 20. I understand that I may not work as a confidential informant with any law enforcement agency while I am in DUI Court, nor may I be made or encouraged to work as a confidential informant as a condition of my full participation in the DUI Court program. 21. I understand that I may not participate in DUI Court if I am currently an affiliated gang member.

18 22. I will inform all treating physicians that I am a recovering addict and that I may not take narcotic or addictive medications or drugs. If a treating physician wishes to treat me with narcotic or addictive medications or drugs, I must disclose this to my DUI Court treatment provider and get specific permission from the DUI Court Team to take such medication. 23. I agree to be responsible for what goes into my body that may affect alcohol/drug test results. Before taking medication of any kind, I will check with the pharmacist to ensure that it is non-narcotic and non-addictive and that it contains no alcohol. I will obtain pre-approval for any and all medications, prescribed or over-thecounter, with the DUI Court Office. 24. I agree that I will not leave any treatment program (halfway house, inpatient facility, etc.) without prior approval of the DUI Court Team. 25. I understand that my individual course of treatment may include residential treatment, education, and/or self-improvement courses such as anger management, parenting, or relationship counseling. 26. I understand that I am required to maintain approved full-time employment or full- time school enrollment at all times while in the program. If I am not gainfully employed or in school full-time, I may be required to provide the DUI Court Team with proof of my job search, apply to or interview with a certain number of employers on a daily basis, meet with DUI Court personnel on a daily basis, and/or complete community service on a daily basis until I secure employment and begin working or enroll in school and begin attending classes. 27. I understand that I will be required to reside within twenty-five (25) miles of Cumming, Georgia throughout the duration of my participation in the DUI Court program, including the maintenance and aftercare phase, unless otherwise approved by the Court. 28. I agree to keep the DUI Court Office and Probation Department advised of my current address and phone number at all times and obtain prior approval to change my address and phone number. My place of residence is subject to DUI Court approval, and I will not move or stay outside the twenty-five (25) mile radius of Cumming, Georgia without prior approval from the DUI Court Team. 29. As a condition of participation in this program, I agree to the search of my person, property, place of residence, vehicle, and personal effects at any time with or without a warrant, and with or without probable cause, when required by a probation officer, treatment staff, DUI Court staff, and/or law enforcement officer. 30. I agree to execute the Consent for Disclosure of Confidential Substance Abuse Information. I understand that any information obtained from this release will be kept in the files of the treatment provider and/or in the probation officer s confidential file. 31. I understand that my failure to successfully complete and graduate from the DUI Court program may result in my probation being revoked. 32. I understand that I am not to purchase any alcoholic beverages or drugs or enter an establishment where alcohol sales comprise fifty percent or more of their business, even if I am of legal age to purchase alcohol. 33. I understand that if my urine screen, breath test, or any other form of substance testing indicates a positive result, at any time while in the program, I will receive a sanction from the DUI Court Team. I understand that the Court will not conduct any evidentiary hearing to allow me to contest such a result and that I will not be allowed to submit any separate results from any other laboratory or testing process.

19 34. I understand that if I test positive for alcohol or if the DUI Court Team has reason to believe that I am using alcohol while in the program, I may be placed on an alcohol detection device and will be financially responsible for all costs involved. 35. I understand that if I miss an alcohol/drug screen for any reason, I will receive a sanction and may be ordered to be placed on an alcohol detection device and will be financially responsible for all costs involved, unless otherwise ordered by the Court. 36. I understand that if I am ordered to a curfew monitoring service, I will be financially responsible for all costs involved, unless otherwise ordered by the Court. 37. I understand that, if my individualized treatment plan calls for residential/halfway house/or similar specialized treatment, or if my treatment plan with the treatment provider must be extended, I will be responsible for those additional costs, unless otherwise ordered by the Court. 38. I understand that, during court and treatment sessions and periods of incarceration, arrangements must be made for the care and supervision of any children I have who are under the age of 18 years old. If such children are brought to the courtroom, they MUST be accompanied by a non-dui Court participant at all times. 39. I understand that if I exhibit behaviors of harm to myself or others, confidentiality will no longer apply, and the proper authorities and my emergency contact will be notified. 40. I understand that all facial jewelry and tongue piercings must be removed for all judicial meetings/court sessions and while at the treatment facility for any reason. 41. I understand that I am subject to the rules and regulations set out in the Participant Handbook and in any policy documents given to me by the DUI Court. I understand that the Handbook may be revised from time to time, and I will be expected to read and abide by any revised Handbooks that may be distributed. 42. I understand that, once I have been accepted into this program, I will be considered a participant in this program and subject to all program rules and requirements until such time as I am formally discharged by the DUI Court Judge. Discharge will occur in the event of: 1) successful completion and graduation from the program, 2) termination from the program by order of the Court, or 3) withdrawal by permission of the DUI Court Judge. I will not at any time have the option to unilaterally withdraw from the program, even if I am facing a sanction. 43. I understand that my graduation from this program will be contingent upon the results of a check of my criminal and driving histories, a final alcohol/drug screen, which may be administered on the day of my scheduled graduation, and DUI Court Team approval. I understand that a positive result on this test may lead to a sanction, including termination, or to my return to active treatment. 44. I agree to allow my treatment counselor or other DUI Court personnel to visit me in my home or elsewhere. 45. I agree to avoid people or places of disreputable or harmful character. I understand that this includes people currently on probation or parole and people with felony convictions, drug users, and drug dealers. 46. I agree to avoid further violations of the law; however, I understand that if I am arrested or cited, I must report such arrest or citation immediately to the DUI Court Office and DUI Court Probation Officer. I further understand that any such arrest or citation, and/or failing to immediately disclose such arrest or citation, may subject me to sanctions up to and including jail time and/or termination from the program. I have read the above contract, or had it read to me, and acknowledge that I understand all of its terms and conditions. I have been given the opportunity to ask any questions that I may have. I hereby voluntarily enter into this agreement with the Forsyth County DUI Court program.

20 Defendant s Full Name (print) Defendant s Signature Date Attorney for Defendant (print) Bar Number Date Attorney s Signature SO ORDERED, this day of, 20. Chief Judge, State Court of Forsyth County

21 Forsyth County DUI Court State Court of Forsyth County T. Russell McClelland, III Jennifer O Kelley DUI Court Judge Coordinator CRIMINAL HISTORY CONSENT FORM I hereby authorize the Forsyth County DUI Court or Forsyth County Solicitor s Office to receive any criminal history information pertaining to me that may be in the files of any criminal justice agency of any state or in the files of any local criminal justice agency in the State of Georgia both now, for purposes of screening for DUI Court eligibility, and continually for five years after my completion of the program, if I am accepted into the program. FULL NAME (PRINT) ADDRESS CITY STATE ZIP CODE SEX RACE DOB SOCIAL SECURITY NUMBER DRIVER S LICENSE NUMBER STATE SIGNATURE DATE

22 Forsyth County DUI Court State Court of Forsyth County T. Russell McClelland, III Jennifer O Kelley DUI Court Judge Coordinator ALCOHOL/DRUG SCREEN DRIVING POLICY I understand that if I test positive on any instant result alcohol and/or drug test at any time during my involvement with DUI Court, then I am not to operate a motor vehicle. I will immediately surrender my automobile keys to staff and call someone for a ride home. DEFENDANT S FULL NAME (PRINT) DRIVERS LICENSE NUMBER STATE DEFENDANT S SIGNATURE DATE

23 Forsyth County DUI Court State Court of Forsyth County T. Russell McClelland, III Jennifer O Kelley DUI Court Judge Coordinator FRATERNIZATION RULES I,, having requested to participate in the Forsyth County DUI Court program, understand and agree to the following: Any sexual involvement with any DUI Court participant is prohibited under any circumstances. DUI Court participants may not be employed by the same employer or work together, whether paid or unpaid, without Court approval. DUI Court participants may not loan one another money, clothing, or other personal items. DUI Court participants may not perform, offer to perform, or solicit professional, technical, or vocational services for any other participant, without Court approval. I have read this document or had it read to me and have been given the opportunity to ask any questions I may have. I hereby agree to abide by the above rules as a condition of my participation in the DUI Court program. I understand that any violation of these rules may result in a sanction up to and including termination from the program. This, the day of, 20. DEFENDANT S FULL NAME (PRINT) DEFENDANT S SIGNATURE

24 Forsyth County DUI Court State Court of Forsyth County URINE TESTING AND INCIDENTAL ALCOHOL EXPOSURE CONTRACT I understand I will be tested for the presence of alcohol and other drugs to include, but not limited to, designer drugs and substances not fit for human consumption on a random basis according to procedures established by the DUI Court team and/or treatment provider. I understand it is my responsibility to report to the assigned location at the time period given for the test. I understand that if I am late for a test, or miss a test, it will be considered as a positive test for alcohol or other drugs and that I will be sanctioned. I understand that if I fail to produce a urine specimen or if the sample is not of sufficient quantity, it will be considered as a positive test and that I will be sanctioned. I have been informed that the ingestion of excessive amounts of fluids can result in an invalid or diluted urine sample, and I understand that my urine sample will be tested to ensure the sample is not invalid or diluted. I understand that if I produce an invalid or diluted sample (intentionally diluted or not), it will be considered as a positive test for alcohol or other drugs and I will be sanctioned. I understand I am not allowed to possess or consume creatine or creatinine supplements or products and will be sanctioned as being in possession of contraband. I understand that substituting or altering my specimen or trying in any way to modify my bodily fluids or other specimens for the purposes of changing the drug-testing results will be considered as a positive test for drugs/alcohol and will result in sanctions and will be grounds for immediate termination from the DUI Court. It is YOUR responsibility to limit your exposure to the products and substances detailed below that contain ethyl alcohol; however, this list is not all inclusive. It is YOUR responsibility to read product labels, to know what is contained in the products you use and consume and to stop and inspect these products BEFORE you use them. Use of the products detailed below in violation of this contract will NOT be allowed as an excuse for a positive test result. When in doubt, don t use, consume, or apply. Cough syrups and other liquid medications: DUI Court participants have always been prohibited from using alcohol-containing syrups, such as Nyquil, other cough syrup brands, and other liquid medications that rely upon ethyl alcohol as a solvent. DUI Court participants are required to read product labels carefully to determine if they contain ethyl alcohol (ethanol). All prescription and over-the-counter medications should be reviewed with your case manager before use. Information on the composition of prescription medications should be available upon request from your pharmacist. Nonalcohol containing cough and cold remedies are readily available at most pharmacies and major retail stores. Non-alcoholic Beer and Wine: Although legally considered non-alcoholic, NA beers (e.g. O Doul s, Sharp s ) do contain a residual amount of alcohol that may result in a positive test result for alcohol, if consumed. DUI Court participants are NOT permitted to ingest NA beer or NA wine.

25 Food and Other Ingestible Products: There are numerous other consumable products that contain ethyl alcohol that could result in a positive test for alcohol. Flavoring extracts, such as vanilla or almond extract, and liquid herbal extracts (such as Gingko Biloba), could result in a positive screen for alcohol or its breakdown products. Communion wine, food cooked in wine, and flambe dishes (alcohol poured over a food and ignited such as Cherries Jubilee, Baked Alaska) must be avoided. Read the labels on any liquid herbal or homeopathic remedy carefully and do not ingest any without approval from the case manager. Mouthwash and Breath Strips: Most mouthwashes (Listermint, Cepacol, etc.) and other breath cleansing products contain ethyl alcohol. The use of mouthwashes containing ethyl alcohol can produce a positive test result. DUI Court participants are required to read product labels and educate themselves as to whether a mouthwash product contains ethyl alcohol. Use of ethyl alcohol-containing mouthwashes and breath strips by DUI Court participants is not permitted. Non-alcohol mouthwashes are readily available and are an acceptable alternative. If you have questions about a particular product, bring it in to discuss with the case manager. Hand sanitizers: Hand sanitizers (e.g. Purell, Germex, etc.) and other antiseptic gels and foams used to disinfect hands may contain up to 70% ethyl alcohol. Excessive, unnecessary or repeated use of these products could result in a positive urine test. Hand washing with soap and water is just as effective for killing germs. Energy Drinks: Energy drinks (e.g. Red Bull, Rockstar, Monster, etc.) can produce a positive reading on an alcohol test, and therefore, must be avoided by DUI Court participants. Energy drinks are considered a stimulant and should not be consumed by participants of the DUI Court Program. Hygiene Products: Aftershaves and colognes, hair sprays and mousse, astringents, insecticides (bug sprays such as Off ) and some body washes contain ethyl alcohol. While it is unlikely that limited use of these products would result in a positive test for alcohol (or its breakdown products) excessive, unnecessary or repeated use of these products could affect test results. Participants must use such products sparingly to avoid reaching detection levels. Just as the Court requires DUI Court participants to regulate their fluid intake to avoid dilute urine samples, it is likewise necessary for each participant to limit their use of topically applied (on the skin) products that contain ethyl alcohol. Solvents and lacquers: Many solvents such as lacquers, and surface preparation products which are used in industry, construction, and the home, contain ethyl alcohol. Both excessive inhalation of vapors and topical exposure to such products can potentially cause a positive test result for alcohol. Make sure to wear gloves, a respirator, and have plenty of ventilation when using these products. DUI Court participants must educate themselves as to the ingredients in the products that they are using. There are alternatives to nearly any item containing ethyl alcohol. Frequency of use and duration of exposure to such products should be kept to a minimum. A positive test result will not be excused by reference to use of an alcohol-based solvent. If you are in employment where contact with such products cannot be avoided, you need to discuss it with the case manager. Do not wait for a positive test result to do so. Remember when in doubt, don t use, consume, or apply!!!!!!! I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES: Printed Name Participant Signature Date

26 Forsyth County DUI Court State Court of Forsyth County T. Russell McClelland, III Jennifer O Kelley DUI Court Judge Coordinator ASSESSMENT ALCOHOL/DRUG SCREENS I understand that I may be screened for alcohol and/or drugs during the assessment/application process. These screens are used to help determine eligibility for the DUI Court program. Unless I am on probation, a positive test will not be held against me. If I am on probation and test positive during the assessment/application process, I understand that my probation officer may be notified. I understand that if I use alcohol and/or drugs after being admitted to the program, I could receive sanctions up to and including jail or termination for my re-use. Print Name/ Defendant Defendant/ Signature Date

27 Phase 1-Orientation (8 weeks) 2 counseling groups per week (Wed from 5-7pm & Fri from 5-7pm) DUI School & Clinical Evaluation must be completed within 120 days in order to be eligible for Ignition Interlock Driving Permit Random drug/alcohol testing Random drug/alcohol testing (Sun-Sat, 7-9am unless (Sun-Sat, 7-9am unless otherwise directed) otherwise directed) Screen Line # Screen Line # Documentation of 3 approved recovery meetings per week Obtain recovery sponsor Phase 2-Transitional Phase 3-Maintenance (22 weeks) (22 weeks) 2 counseling groups per week (Mon from 7-9pm & Wed from 7-1 counseling group per week 9pm) (Tues from 7-8:30pm) Documentation of 3 approved recovery meetings per week Complete Victim Impact Program & Alcohol Awareness Class Random drug/alcohol testing (Sun-Sat, 7-9am unless otherwise directed) Screen Line # Documentation of 3 approved recovery meetings per week Phase 4-Aftercare (24-52 weeks) 2 counseling groups per month (1st & 3rd Thursday of the month from 4-5:30pm) Begin paying Court Fines after 12 months (up to half of fine can be credited at the discretion of the Court) Random drug/alcohol testing (Sun-Sat, 7-9am unless otherwise directed) Screen Line # Documentation of 3 approved recovery meetings per week 240 hours of csw credited through completion of program requirements Report DUI Court to probation twice/month 1x per on month Report DUI Court to probation twice/month 1x per on month Report DUI Court to probation once/month 1x on per month Report to probation 1x per month 3:00pm; 2:30pm. Dates will be provided. 3:00pm; 2:30pm. Dates will be provided. 4:00pm; 3:30pm. Dates will be provided. DUI Court once/month on 4:00pm; 3:30pm. Dates will be provided. $ Counseling/Program Fee due the 15th of each month $ Counseling/Program Fee due the 15th of each month $ Counseling/Program Fee due the 15th of each month $ Counseling/Program Fee due the 15th of each month (payable to the DUI Court Office-- (payable to the DUI Court Office-- (payable to the DUI Court Office-- (payable to the DUI Court Office-- money orders only) money orders only) money orders only) money orders only) $69.00 to Probation due the 20th of each month (money orders only) $69.00 to probation/month (money orders only) $69.00 to probation/month (money orders only) $69.00 to probation/month (money orders only) Curfew from 10:00pm-6:00am (unless otherwise directed) Complete Giving Back Project (minimum of 24 volunteer hours) Straight 30 days documented sobriety & without jail time sanctions prior to moving to next phase. Straight 60 days documented sobriety & without jail time sanctions prior to moving to next phase. Straight 90 days documented sobriety & without jail time sanctions prior to moving to next phase. Straight 90 days without jail time sanctions & 120 days documented sobriety prior to graduating from program. Please note the following: Participants are subject to 4th Amendment Waiver Searches in each phase & are required to complete a Firearms Affidavit. It is the policy of the DUI Court Program that you may not work in a bar or restaurant where alcohol is served, nor may you work in any establishment where the primary sales are alcohol, such as a package store unless otherwise approved by the DUI Court in advance. Additionally, you may not work where narcotics, dangerous drugs, or other mood altering substances are available unless otherwise approved by the DUI Court in advance. These are general guidelines of the requirements for the Forsyth County DUI Court Program. Phases may be longer due to sanctions. Participants will be required to submit an application to the DUI Court Office to move from one phase to the next or to graduate. If there are any questions, contact the DUI Court Office at (678)