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Making Peace Workshop Referral

Making Peace Application

  • MDJDistrict #Docket #Phone #ContactFaxEmail 
  • YAPContactPhone #Case #EmailFax # 
  • OtherContactPhone #Case #EmailFax 
  • ChargeProbation Ending PeriodBrief Description of OffenseConsequences Assigned 
  • Name of the other party 
  • Youth NameDate of BirthGenderEthnicityAddress 
  • Parent/Guardian 1 NameRelationship to youthPlease indicate special language needs:Parent/ Guardian 2 NameRelationship to YouthPlease indicate special language needs: 
  • YouthGuardian 1Guardian 2Guardian 3