TAGIT APPLICATION

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TAGIT Application

Please download, complete, and return the following application to our office, or upload it below.

CLICK TO DOWNLOAD

TAGIT Online Application

PERSONAL DATA INFORMATION:

* Indicates required field

Name *

First

Last

Today's Date *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone *

Cell Phone *

Work Phone *

Date Of Birth *

Choose One *

Male Female

Current Employment Status *

Place Of Employment *

Highest Level Of Education *

Current Grade In School *

School Currently Attending *

EMERGENCY CONTACT INFO:

Name Of Emergency Contact *

First

Last

Email *

Relationship To Applicant *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone *

Cell Phone *

Work Phone *

OTHER INFORMATION:

Name Of Person Who Referred You To TAGIT *

First

Last

Phone Number *

Name Of Caseworker *

First

Last

Phone Number *

LEGAL HISTORY:

Are You Legally Mandated To Participate In The TAGIT Program? *

Yes No

If Yes, By Whom? *

Court Other

Explain *

If Answer Is Court, Please List County Of Origin *

Are You Currently, Or Will You Be Under Legal Supervision? *

Yes No Maybe Unsure

If You Answered Yes, What Is Your Method Of Reporting? *

Phone Letter Email Online In Person Other

Check All That Apply

If You Answered Other, Please Explain: *

How Often Do You Report? *

Time Remaining: *

Name Of Probation Officer *

First

Last

Agency *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Are Any Of The Following Pending Against You? *

Arrest Warrant Court Appearance Criminal Charges Sentencing None Of The Above

Please Check All That Apply

If You Checked Any Of The Above, Please Explain: *

List All Arrests And Convictions:

Date *

Charges *

Conviction *

Yes No

Were Drugs Involved? *

Yes No

Was Alcohol Involved? *

Yes No

Sentence *

Time In Jail *

Date *

Charges *

Conviction *

Yes No

Were Drugs Involved? *

Yes No

Was Alcohol Involved? *

Yes No

Sentence *

Time In Jail *

Date *

Charges *

Conviction *

Yes No

Were Drugs Involved? *

Yes No

Was Alcohol Involved? *

Yes No

Sentence *

Time In Jail *

Date *

Charges *

Conviction *

Yes No

Were Drugs Involved? *

Yes No

Was Alcohol Involved? *

Yes No

Sentence *

Time In Jail *

Date *

Charges *

Conviction *

Yes No

Were Drugs Involved? *

Yes No

Was Alcohol Involved? *

Yes No

Sentence *

Time In Jail *

Have You Ever Been In Detention Or Prison? *

Yes No

Additional Comments *

Did Anyone Assist The Applicant In Filling Out This Form? *

Yes No

If Yes, Please List The Name Of The Person *

Relationship Of Person To Applicant *

Phone Number *

Optional File Upload *

Max file size: 20MB

Optional File Upload *

Max file size: 20MB

The undersigned student applicant fully acknowledges that the information provided herein is accurate and true to the best of his or her knowledge, and that the application form has been completed and filled out by the student applicant by him/herself. Student applicant further understands that any false or incomplete information may cause and result in disqualification from admittance into the program, whether the student is just entering into, or is already in the program.

Electronic Signature Of Applicant *

Date *

Submit

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