Section 1 of 1 in this document
82nd District Court Ogemaw County Monthly Probation Check-In
Email
*
Has your email address changed in the last 30 days?
*
Choose One
Yes
No
Full Name
First Name
*
Initial
*
Last Name
*
Physical Address
Street Address
*
City
*
State
*
Zip
*
Mailing Address (If different from above)
Street Address
City
State
Zip
Has your phone number changed in the last 30 days?
*
Choose One
Yes
No
Phone Number
*
Who do you live with?
*
Are you a student?
*
Choose One
Yes
No
What is your current employment status?
*
Choose One
Not Employed
Seeking Employment
Employed Seasonally
Employed Part-Time
Employed Full-Time
Disabled and receiving SSI/SSD
Disabled and NOT receiving SSI/SSD
Laid Off
Retired
Other (Explain below)
If you chose "Other" above, please explain
If you are employed, What company do you work for and what type of work do you do?
Do you currently receive any state or federal assistance?
I do not receive assistance
Cash Assistance
Childcare Assistance
Food/EBT
Housing Assistance
Medicaid
Unemployment Benefits
Utility Assistance
WIC
None
Are you currently taking any medications, vitamins or supplements?
*
Choose One
Yes
No
Have you used any drugs or alcohol since your last report? If yes, explain.
*
Have you drug tested since your last report? If yes, when and where?
*
Are you currently participating in any of the following programs? (Check all that apply)
Mental Health Counseling
Substance Use Counseling
Medically Assisted Treatment
Support Meetings (AA, NA, Al-Anon, Smart)
Domestic Violence Classes
Anger Management
Other
None
Do you currently have any upcoming appointments? If so when?
*
Please upload proof of attendance for any programming, testing, support meetings and/or community service since your last report.
Click Here to Upload
Have you had police contact since your last report to probation? If yes, explain.
*
Comments: Please enter any additional information you feel would be helpful for the Probation Department to know.
Do you need the probation department to contact you?
Yes
No
By submitting this report, you are acknowledging, under penalty of perjury, the responses to these questions are true to the best of your knowledge, information, and belief.
I agree
I disagree
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First Name
Last Name
Email
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