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Certification and Program Forms

Starting a Program

There are approximately 55 Court Alcohol and Drug Programs within the state. A listing of these Programs is available from the Indiana Office of Court Services. These programs are governed by statute (IC 12-23-14) and by Court Alcohol and Drug Program Rules.

Certification

Court Alcohol and Drug Programs in Indiana are governed by statute (IC 12-23-14) and Judicial Conference Rules. Statutes and rules authorize the Indiana Office of Court Services to establish procedures to certify court alcohol and drug programs.

Client Demographics

Client Demographics are due March 31, 2024 for the 2023 reporting period. Please complete all applicable forms pertaining to your program. There will be separate links for Felony charges (Part 2) and Misdemeanor charges (Part 3).

Documents and Forms

Document/Form
Staff Update Form
Client Demographics - Part 1
Client Demographics - Part 2 (Felony)
Client Demographics - Part 3 (Misdemeanor)

Confidentiality Forms

Document/Form   
Sample Criminal Justice Consent for Release of Information Form WordPDF
Sample General Consent for Release of Information Form WordPDF
Sample Response to Subpoena - Criminal WordPDF
Sample Response to Subpoena - Civil WordPDF
Sample Prohibition on Re-Disclosure WordPDF

Sample Forms

Document/Form   
Orientation Form WordPDF
Client Rights Form WordPDF
Client Signature Page WordPDF
Assessment Form WordPDF
Individual Service Contract Sample WordPDF
Sample Client Survey WordPDF
Sample Referral Agreement WordPDF

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