Court Referral for Alive at 25 Traffic School

Name: __________________________________________	 Date of Birth: ___________________ 			
Address: _______________________________________________________    Phone#: ___________________
Driver’s License #: __________________________________   Driver’s License State: ___________________ 
Case #: ___________________   Charge/Offense: _______________________________________________________
Court: _________________	Judge: _________________	Phone: _________________ 	
Fax:   ___________________

Register at:

	_________________________________________ 
_________________________________________
_________________________________________
______________________, MT
Phone:  ____________________________________			

ENROLLMENT:  You must call the Montana Highway Patrol and enroll within 24 hours.   

PROGRAM: You are ordered to complete the Alive at 25 Program.  The cost of this program is FREE.

MUST COMPLETE PROGRAM BY:  _____________________________________________________

PREVIOUS TRAFFIC SCHOOL:  Defendant  has (date:  _____________________)  has not attended a previous traffic school.  

NOTICE:  Your failure to comply with this court order may result in a warrant being issued for your arrest and your driver’s license being suspended.

You may not be under the influence of alcohol or illegal drugs at traffic school.  You will be referred back to court if the traffic school determines that you are under the influence.
	 
COMMENTS:  ____________________________________________________________________________

															 Date 		Signature of Defendant    				Date 		Signature of Judge				

___________________________________________ Office Use Only __________________________________________________  
 did	  did not  register for  Traffic School    Signed:  _______________________________  Dated:  _______________
 did	  did not  complete Traffic School        Signed:  _______________________________  Dated:  _______________

cc:	____________	 City Prosecutor    Defendant 	 Defendant’s attorney	 Alive at 25