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List of Forms


Form When to be used
Criminal Case Management Referral Form To refer case to Leon County VTC Coordinator for review of eligibility
Department of Veterans Affairs Request for and Authorization to Release Medical Records or Health Information Included with referral form to allow the Veterans Justice Officer (VJO) to access VA records to assist with review of eligibility
Department of Veterans Affairs Form 10-10EZ and Supplement Form Included with referral form when a Veteran is registered in another VA region besides the North Florida/South Georgia region; allows the VJO to access records from Veterans original VA region to assist with review of eligibility
Leon County VTC Consent for Disclosure of Confidential Information Included with referral form; allows for release of approved treatment information between individuals /programs/facilities while Veteran is enrolled in Leon County VTC
Leon County VTC Participation and Graduation Contract Signed by the Veteran and his/her Defense Attorney upon entry into the Leon County VTC indicating the Veteran understands the rules and requirements of the program and for graduation
Acknowledgement of Receipt of Leon County VTC Participant Handbook Signed by the Veteran and his/her Defense Attorney upon entry into the Leon County VTC indicating they have been given a Leon County VTC participant handbook and will review its content
Intake Essay Requirements Identifies content for intake essay that must be completed in Phase 1
Graduation Essay Requirements Identifies content for graduation essay that must be completed two weeks prior to graduation ceremony