Juvenile Report Form


Probation Officer:  (Select One):  
Your Name: 



Zip Code

Any plans on moving? 

If Yes, where and when

Are you attending school?  (Type Yes or No)

If yes, what classes are you taking and what are your current grades?
Have you received any detentions or in school suspensions? (Type Yes or No)
If Yes, when and for what reason:

Are you working? (Type Yes or No)


Date of Employment:

How many hours per week?


Boss's Name:

Do you owe any money to the court? (Type Yes or No)

How much still owed?

Date of last payment:

Amount Paid:

Are you attending counseling or treatment? (Type Yes or No)

Where and/or counselor name:

Date of last appointment:

Date of next appointment:

Are you attending N.A. or A.A.?  (Type Yes or No)

If so, how often?

Are you taking medication? (Type Yes or No)

If so, what medication and for what reason:

Have you been ticketed, arrested, involved in an accident, or charged with any new offenses in the past 4 weeks? (Type Yes or No)

If yes, where did the incident occur?

If yes, what was the incident?

If yes, when was the incident?

If yes, what is your court date?

Have you completed any public service hours? Type Yes or No

If yes, how many hours?

If yes, location of public service work:

I certify the above information to be true and correct and I understand that any falsification of my answers is a violation of my court ordered Probation/Supervision.
Signature Minor: 
Signature Parent/Guardian: