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USE ONLY   |\n| --- | --- |\n| NAME OF DEFENDANT:  \u003Cbr>STREETADDRESS:  \u003Cbr>ZIPCODE:  \u003Cbr>STATE:  \u003Cbr>CITY:   |  |\n| DATE OF COURT ORDER:   |  |\n| (check one):  \u003Cbr>PROOF OF ENROLLMENT IN ALCOHOL OR DRUG PROGRAM  \u003Cbr>□PROOF OF COMPLETION OF ALCOHOL OR DRUG PROGRAM   |  |\n|  | CASE NUMBER:   |\n\n\n| DESCRIPTION OF ALCOHOL OR DRUG PROGRAM  \u003Cbr>Name of program:   |  |\n| --- | --- |\n|  |  |\n| Address of program:   |  |\n| Program license number:   | Program telephone number:   |\n\n# PROOF OF ENROLLMENT\n\n## 1.Defendant (name):\n\nenrolled in the alcohol or drug education program  \ndescribed above on(specify date of enrollment):  \nI declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.  \nDate:  \n(TYPE OR PRINT NAME)  \n(SIGNATURE OF DEFENDANT)  \nDate:  \n(TYPE OR PRINT NAME)  \n(SIGNATURE OF PROGRAM DIRECTOR OR INSTRUCTOR)  \n(TITLE)  \nPROOF OF COMPLETION  \nsuccessfully completed the alcohol or drug education  \n## 2.Defendant (name):\n\nprogram described above on(specify date of completion):  \nI declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.  \nDate:  \n(TYPE OR PRINT NAME)  \n(SIGNATURE OF DEFENDANT)  \nDate:  \n(SIGNATURE OF PROGRAM DIRECTOR OR INSTRUCTOR)  \n(TYPE OR PRINT NAME)  \n(TITLE)  \n\n| —INSTRUCTIONS—  \u003Cbr>YOU NEED TWO OF THESE FORMS:  \u003Cbr>1.UPON ENROLLMENT IN A COURT-ORDERED ALCOHOL OR DRUG EDUCATION PROGRAM,FILL OUT THE PROOF OF ENROLLMENT  \u003Cbr>PORTION OF ONE COPY OF THIS FORM AND FURNISHIT TO THE SENTENCING COURT WITHIN THE TIME AND IN THE MANNER  \u003Cbr>SPECIFIED BY THE COURT.  \u003Cbr>2.UPON SUCCESSFUL COMPLETION OF THE PROGRAM,FILL OUT THE PROOF OF COMPLETION PORTION OF A SECOND COPY OF THIS  \u003Cbr>FORMAND FURNISHIT TO THE SENTENCING COURT WITHIN THE TIME AND IN THE MANNER SPECIFIED BY THE COURT.  \u003Cbr>FAILURE TO COMPLY WITH THESE REQUIREMENTS MAY RESULT IN THE REVOCATION OF YOUR PROBATION.  \u003Cbr>SI USTED NO CUMPLE CON ESTOS REQUISITOS,SU INCUMPLIMIENTO PUEDE RESULTAREN LA REVOCACION DE SU LIBERTAD  \u003Cbr>CONDICIONAL.  \u003Cbr>Page 1 of    |\n| --- |\n\nForm Approved for Optional Use  \n# PROOF OF ENROLLMENT OR COMPLETION\n\n          ALCOHOL OR DRUG PROGRAM  \nSave this form  \nPrint this form","cbCaivPmuxrdWAXf","https://ap.wps.com/l/cbCaivPmuxrdWAXf","pdf",65895,"English","# Proof of Enrollment\n## Defendant (name)\n# Proof of Completion\n## Defendant (name)\n# Instructions","[{\"question\":\"What information is required to complete this form?\",\"answer\":\"Enter defendant identification details, the alcohol or drug program description (including program name, address, license number, and telephone number), the court order date, and the case number.\"},{\"question\":\"When should the enrollment portion be filled out and submitted?\",\"answer\":\"Fill out the proof of enrollment portion upon enrollment in the court-ordered program and furnish it to the sentencing court within the time and manner specified by the court.\"},{\"question\":\"What happens if the required enrollment and completion documents are not provided?\",\"answer\":\"Failure to comply with the submission requirements may result in revocation of your probation.\"}]","Proof of Enrollment or Completion - Alcohol or Drug Program | PDF"]