Drug Court Trip Request

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    Your Name (first and last):

    Your Email:

    Your Home Phone Number:

    Your Drug Court Tracker:

    Your Counselor:

    Has your trip been approved in group?:
    YesNo

    Trip Destination:

    Departing Date and Time:

    Returning Date and Time:

    Explain the purpose of your trip:

    I understand that this application is only a request for a trip and I may not travel until I have heard an affirmative answer from my tracker.

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