Fill and Sign the Disposition Sheet Probation Revocation or Aftercare Violation Form

COVER SHEET STATE OF ARKANSAS CIRCUIT COURT: JUVENILE DELINQUENCY/EJJ 1 6/1 /2017 This delinquency/EJJ cover sheet is required by Supreme Court Administrative Order 8 to be completed and filed for every juvenile. The data contained herein shall not be admissible as evidence in any court proceeding or replace or supplement the filing and service of pleadings, orders, or other papers as required by law or Supreme Court rule. Instructions are located at www.courts.arkansas.gov . County: District: Filing Date: Judge: Division: Case ID: Case Type (select one) :  (JD) Delinquency  (EJ) Extended Juvenile Jurisdiction Is this an amendment?  Yes  No If yes, reason: Does this juvenile ha ve other active cases ?  Yes  No Case ID s: Juvenile information Last Name Alias Suffix Address First Name Middle Name City Contexte ID State DLN/State ID ZIP SSN Custody date Date of Birth Arrest date Sex □ Male □ Female  ATN  Ethnicity □ Hispanic □ Non -Hispanic  Was this a school -related arrest? □ Yes □ No  Race Check one □ Bir acial □ Asian/Pacific Islander □ Black □ American Indian/Alaska Native □ Unknown □ White  School Status Check one □ Under school age □ Enrolled □ Home -school ed □ Truant/Not attending □ Suspended □ Expelled □ Withdrawn □ GED obtained □ Graduated High School  Educational Accommodation □ IEP □ 504 □ N/A Interpreter needed? □ None □ Spanish □ Sign Language □ Other:  Parent /Guardian 1 Parent /Guardian 2 Relationship Relationship Last Name Last Name Suffix Suffix First Name First Name Middle Name Middle Name DL N/State ID DL N/State ID SSN SSN Date of Birth Date of birth Address Address City, State ZIP City, State ZIP Email Email Interpreter needed? □ None □ Spanish □ Sign Lang. □ Other: Interpreter needed? □ None □ Spanish □ Sign Lang. □ Other: COVER SHEET STATE OF ARKANSAS CIRCUIT COURT: JUVENILE DELINQUENCY/EJJ 2 6/1 /2017 The offenses in the attached information include: Code # Offense name/Description A/S/C Offense Date Counts F/M Class Other Juveniles /Defendants: Related Case IDs : Attorney Providing Information : Bar #: Email Address: Phone: Manner of filing (choose one) : □ (MF O) Original □ (MFR JD) Re -Open Delinquency ( if so, why? ): □ Probation revocation □ DYS Aftercare Violation □ Contempt □ (MFREJ) Re -Open EJJ (if so, why? ): □ EJJ Review Hearing □ DYS Release Hearing □ (MFT) Transfer from another jurisdiction □ (MFT C) T ransfer from Criminal Division to EJJ : date of transfer hearing : Was juvenile’s attorney present? □ Yes □ No  If a detention hearing related to this petition has already occurred, D ate of detention hearing (HD60) : Detention hearing outcome: □ Continue detention □ Release on personal recognizance □ Release to parent/guardian/custodian □ Release to qualified person/agency □ Reasonable restrictions □ Release upon order to appear □ Re lease upon bond Was juvenile’s attorney present? □ Yes □ No