Electronic Diversion Application

Basic Personal Information

Information about you and how to make contact with you.
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date of Birth
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Is your mailing address the same as your physical address?

Yes.No.
Physical Address

Street Address

Street Address Line 2

CityState

Zip Code
Have you had your current mailing address for at least six months?*

Yes.No.
Previous Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code
Do you have a driver's license?*

Yes.No.
Driver's License Number*
Is your driver's license a Commercial Driver's License?*

YesNo
Phone Number (Home/Cell)*

Area CodePhone Number
Phone Number (Work)

Area CodePhone Number
Email Address*
example@example.com; if you do not possess an email, state 'None'.
Family Information

Information about your family life.
Marital Status*
Spouse's Name

First NameMiddle NameLast Name
Relationship Status
Significant Other's Name

First NameMiddle NameLast Name
Do you have any children who reside with you and who are your dependents?*

Yes.No.

Employment Information

Information about your employment situation.
Are you currently employed?*

Yes.No.
Employer Name
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title
Employment Length
How long have you been employed by your employer?
Monthly or Hourly Salary
Supervisor
How long have you been unemployed?
Why did you leave your last job?
Education Information

Information about how much education you've received and the types of schools you've attended.
Have you attended high school?*

Yes.No.
High School Attended
Highest Grade Reached
Have you attended any college or university?*

Yes.No.
College/University Attended
If multiple schools have been attended, state only the one from which you received your highest degree.
Highest Degree Achieved
Criminal History

Information about your previous involvement, if any, with the criminal justice system.
Have you ever been convicted of a crime, either as an adult or a juvenile?*

Yes.No.

Are you currently on probation, parole, or any other kind of supervised release?*

Yes.No.
Have you ever received a diversion from any county attorney or district attorney?*

Yes.No.
Have you ever been granted a diversion and had that diversion revoked?*

Yes.No.
Diversion Eligibility Questions

Inquiries that help determine whether you are eligible for the Stanton County Attorney's diversion program and whether it is a good option for you.
State, in detail, the facts which caused charges to be filed against you in the District Court of Stanton County.*
Why do you feel you can successfully complete the County Attorney's diversion program? Explain why you feel that way.*
Additional Information for Minors

More information required for individuals who are under the age of 18.
Father's Name

First NameMiddle NameLast Name
Mother's Name

First NameMiddle NameLast Name
Do you reside with your parents?*

Yes.No.
Father's Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code
Mother's Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code
Father's Phone Number (Home/Cell)

Area CodePhone Number
Mother's Phone Number (Home/Cell)

Area CodePhone Number

Basic Personal Information