Juvenile Drug Court Juvenile Success Team (Just) Referral Form {RI-JV026}

SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE RI-JV026 JUVENILE DRUG COURT ­ JUVENILE SUCCESS TEAM (JUST) REFERRAL FORM Referral Date: Minor's Name: CID: J#: Age: Mother/Father Foster Parent DOB: Sex: Male Guardian Female Parent/Foster Parent/Guardian Name: Household's Primary Language: English Spanish Other: Ethnicity: Asian/Pacific Islander Native American Hispanic Other: Black/African American Caucasian Address: Street City State Zip Code Home Phone: ( ) - Cell Phone: ( ) - Minor's Cell/Other #: ( ) Grade Level: School Information: District and Name of School: Probation Status: Probation: Ward 790.1 WIC 654.2 WIC 725(a) WIC Home Placement Date: 1. 2. 3. 4. 5. Adjudicated Offense(s): M M M M M F F F F F Dual Status Lead: DPSS Facility: Probation Assigned Probation Officer Phone Number and Email: Name: Phone: ( ) Email: Title: Assigned Social Worker Phone Number and Email: Name: Phone: ( ) Email: Title: Page 1 of 1 Approved for Optional Use Riverside Superior Court Form RI-JV026 [Rev. 05/09/17] JUVENILE DRUG COURT JUVENILE SUCCESS TEAM (JUST) REFERRAL FORM Statutory Authority riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com