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Adult Diversion Report Form

  1. Contact Information

    Cochise County Alternative Prosecution
    Email :
    Telephone No.: (520)432-8700
    Fax No.: (520)432-8778

  2. Instruction

    Complete as directed, (Failure to report can result in revocation from the program,)

  3. I Live:
  4. Means of Transportation
  5. Note Per Hour/Week/Month

  6. Have you had any contact with law enforcement in the last month?
  7. Have you had any problems/difficulties during the past month?
  8. Who is your Diversion Specialist?
  9. Are you currently enrolled in school?
  10. Have you received a summons in the last 30 days?
  11. During the last month have you been named as a defendant in any criminal case?
  12. During the last month month have you appeared in court for any reason?
  13. Have you made a payment on restitution and/or supervision fee?

    Payments Are Now Accepted On-Line

  14. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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  16. This field is not part of the form submission.