Criminal Justice Program Form

Criminal Justice Program Form

Do you have a loved one in Salt Lake County Jail who needs addiction and mental health services? Our Criminal Justice Program (CJP) works with incarcerated people in Salt Lake County to receive treatment while serving their court sentence.
Is your loved one in the Salt Lake County Jail? Please note, this program is only offered in Salt Lake County. If your loved one is in a different County Jail, you can advocate for them to be transferred to Salt Lake County Jail. You will need to work with their' legal team to facilitate this. *

YES NO
Do they have more than 120 days on their sentence? *

YES NO
What level of security are they in? *

Minimum Medium Maximum Not Sure
Have they used drugs/alcohol in the last 6 months? (yes, no) *

YES NO
What is your loved ones Name *

First Name Last Name
What is their date of birth? *

Month Day Year
Date
Are they being represented by a public (LDA) or private attorney? (dropdown: LDA, Private, not sure) *

LDA Private Not Sure
What is their SO number? *
What is your Name? *
What is your phone number? *
Please enter a valid phone number.
What is your email? *
example@example.com
Would you be interested in a family support group for people with incarcerated loved ones? *

YES NO
Should be Empty: