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IN THE COURT OF COMMON PLEAS OF ADAMS COUNTY, PENNSYLVANIACRIMINAL

CQMMONWEALTH OF PENNSYLVANIAPlaintiffVS.

Defendant

No. CP-OI-CR-

ADDICTION DIVERSIONARY PROGR M ORDERAND NOW this day of , 20_ thDefendant is admitted into the Addiction Diversionary Program for a period of six 6)months, subject to standard conditions of the program and any special conditions set forthbelow. Defendant is directed to pay the fees and costs set forth in his/her application andagreement, and to abide by cOllditions set forth therein. Further ptoceeclings on thecharges shall be postponed during the term of the Addiction D i v e r s i o ~ a r y Program. TheDefendant s bail is terminated and any money or other form of security deposited isreturned in accordance with the rules peliaining to baiL The following conditions shallalso apply, if checked:

Defendant must pay restitution as set forth in the application.Other provisions:

The Defendant is directed to appear for re-arraignment onat 8:30 a.m. in a Courtroom to be designated.

BY THE COURT:

Judge

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IN THE COURT OF COMMON PLEAS OF ADAMS COUNTY, PENNSYLVANIACRIMINAL

COMMONWEALT OF PENNSYLVANIAPlaintiffVS.

Defendant

No. CP-OI-CR-

ADDICTION DIVERSIONARY PROGRAMAPPLICATION AND AGREEMENTT, the Defendant above named, hereby apply for adrnission into the AddictionDiversionary Program, and hereby represent and agree as follows:1. Speedy Trial Related Rights: T understand my right to have thecriminal charges against me disposed of in a speedy manner. also understand thatprovisions ofPa.R.Crim.P. 600 give me the right to have trial commence w.ithin 365 daysfrom the elate on which charges were filed against me, and that violation of speedy tria]rigbts and/or the provisions of Rule 600 may give me the right to have all criminalcharges dismissed. Further; understand that prosecution of the charges will bepostponed during my participation in the. Addiction Diversionary Program and that theCom1110i1wealth must be given the right to prosecute me if I am removed from theAddiction Diversiol1.ary Program some time in the futute. In this regard, I understand thefollQwing:A. f I violate conditions of the Addiction Diversionary Program, the Courtmay remove me from the Addiction Diversionary Program and list mycaSe for arraignment; andB. f I am removed from the Addiction Diversionary Program, any delaycaused by participation in and administration of the AddictionDiversionary Program will not be counted against the Commonwealth forRule 600 aild constitutional speedy trial provision purposes. 1 agree that ifmy t1 .ia1 begins beyond the time period permitted by the rule andconstitutional provisions, I will give up any right to claim the benefit ofspeedy trial and Rule 600 provisions in regard to the time period duringwhich I am on the Addiction Diversionary Program. In tbis regard, Iunderstand that impOi tant rights may be given up 01 waived, represent thatI am aware of and l.ll1derstand those tights, and voluntadly, knowingly,and intelligently choose to waive or give up those rights. f I am, for anyreason, refused admission after waiving such rights, my waiver shall beinvalidated.

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2. Financial Responsibilities: As a condition of the Addiction DiversionaryProgram, I agree to pay the slim of 315 for Court costs. I acknowledge that failure tosatisfy my financial responsibilities within the time period of my Addiction DiversionaryProgram admission shall be grounds for removing me from the Addiction DiversionaryProgram. I understand that this lump SLIm 1s comprised of various fees, chcu ges, andcosts. I ul)derstaild that money paid by me will be petiodically distributed to variousentities entitled thereto, and that it would be difficult for the ClerIc of COluis to refundany money after distribution had occurred. I agree that r shall have neither a right ofaccounting nor refbnd as to any money paid by me, should be removed from theAddictlOll Diversionaty Program nor shall be entitled to future credit. All money shallbecome the property of the eiltity entitled thereto, as established by the Clerk of Courts.Further, agree to the followillg:

Lab userRestitution3. Program Conditions The applicant must:

A. Truthfully answer all questions on application for programadmission;

B. Attend. all counseling sessions scheduled with an agencydesignated by the Adams County Department of ProbationServices;C. Pay all CQurt costs, including laboratory user fees, anclrestitutioll as designated at the time of the person s

admission to the progmm;D. Comply with all state and federal laws. In this regard, thefilihg of criminaL cbarges against a program participant is

sufficient for re1110val from the program. t is not necessarythat the charges be concluded and/or result in conviction;

E. Pay all counseling fees in full directly to the approvedcounseling agency and provide receipt for the same to theDepartment of Probation Services;

F. Remain free from the use of non,.presctibed controlledsubstances;G. Subniit to random urinalysis testing by the Department of

Probation Services, or any agency designated by theDepartment of Probation Services, and pays in full all feesrelated to testing; and

H. Report as directed by the Adams County Department ofProbation Services ~ l d advise the Adams County Clerk ofCourts Office, the Adtj 111S County District Attorney s

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OffIce, and the Department of Probation Services of anychange of address within 72 hours of such change.4. Length of Program I understaild that I shall be placed in the AddictionDivel sionary Program for six (6) months, subject to the program conditions set forth inparagraph 3 above and the following special conditions:

I acknowledge that the conditions have beenexplained to me and that I understand them and that viol ation of any condition shallconstitute grounds for my temoval from the Addiction Diversionary Program.5, Successful Completion: I unqerstand that the charges against me will bedismissed if I successfully complete the Addiction Diversionary Program.6. Removal from the Program: I understand that the District Attorney mayrequest y removal from the Addiction Diversionary Program if r do not comply with the

telTIlS and cOl1ditions as described in this application. I waive the right to have the Judgewho placed me in the Addiction Diversionary Program rule on the Commonwealth sl equest and agree that any Judge may decide the maiter. I understand that a Judge mayorder that process should issue for my arrest so that 1 would be produced and be given achance to speak on the matter. I waive the right to be pei sonally present and agree that aJudge may remove me fr 111 the Addiction Diversionary Program, in my absence, if Ihave been given reasonable notice and

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I hereby request the Commonwealth of Pennsylvania to admit me into theAddiction Diversionary Program. I have read and understand the conditions of theprogram.

Defendant

Attorney for Defendant

AGREEMENT BY COMMONWEALTHAND NOW, this day of , 20_ I herebycoMent to the Defetldant s admIssion into the Addiction Diversionary Program inaccordance with his/her application agreerlJ ent.

District Attol cy

Rev. 05 16113