Form Center

2. Defendant's Name:*
4. Defendant's Address:*

   Physical Address (No PO Boxes)

6. Defendant's Mailing Address:*
8. Defendant's Email:

   (Documents will  be sent to this email)

10. Defendant's Phone Number:
11. Referral Date:
12. Deadline to Register:
14. Courts:
    -- Select One --Justice Court 1 (Bisbee)Justice Court 2 (Douglas)Justice Court 3 (Benson)Justice Court 4 (Willcox)Justice Court 5 (Sierra Vista)Justice Court 6 (Bowie)Superior Court
18. If you have an Attorney, please complete
20. Attorney's Name:
22. Attorney's Address:
24. Attorney's Email:

    (Documents will be sent to this email)

25. Attorney's Phone Number:
27. Referral Date:
28. Deadline to Register:
32. Please indicate how you or your client would like to proceed.

    1. No, I (my client) do not (does not) want to resolve this case with Traffic Diversion. I understand that my case will proceed with Traditional Prosecution.
    2. Yes, I (my client) would like to resolve this case with Traffic Diversion. Please email me the necessary documents.
34. Acknowledgment of requirements*

    1. I understand the requirements

    Defendant agrees to complete and provide proof of the following:

    • Check in with the Adult Diversion Coordinator as assigned.
    • Make the monthly $70.00 monthly program fee (Minimum of four months)
    • Complete 10 hours of community service or, in lieu of community service, the Defendant may donate to a Cochise County non-profit in the amount of $10 per hour of community service ordered.
    • Complete Wise Choice Alternatives Driver Responsibility Course or Appropriate Course
    • Remain Law abiding
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field