Ninth Judicial Circuit PTI Application

Prior to submitting your application, you must call or email the PTI office to ensure we have received your referral from the court or prosecutor.
Call: 843-958-1930 or email: divservices@scsolicitor9.org

The PTI program is a privilege. Not everyone is offered this privilege.

Please take advantage of this opportunity to resolve the criminal charges pending against you at this time. Please note PTI is voluntary and your participation in this program is your decision. Failure to disclose pertinent information may result in your case being returned back to court or prosecutor.

ELIGIBILITY CHECK

Have you contacted our office to verify we received your referral from the court or prosecutor?

Yes

Have you ever applied and/or participated in a Pretrial Intervention Program (PTI)?

Yes

APPLICANT INFORMATION

Last Name

First

Middle

JR/III

Nickname/Alias

Maiden Name

SSN

Home Phone

Cell Phone

Race

Gender

Date of Birth

Birth State/Country

Age

DL#

DL State

Do you have a CDL License?

Do you have transportation?

Transportation

Car

Family/Friend

Bus

Taxi/Rideshare

Other

Transfer Request: I am requesting my PTI participation to be transferred to another county.

County to be transferred to:

MAILING ADDRESS:

Street/P.O. Box

Apt./Lot#

City

State

Zip

PHYSICAL ADDRESS:

Street/P.O. Box

Apt./Lot#

City

State

Zip

ATTORNEY/BOND/JAIL INFORMATION

ATTORNEY INFORMATION:

No Attorney

Private Attorney

Public Defender

Name

Street/P.O. Box

City

State

Zip

Phone Number

BOND INFORMATION:

No Bond

PR Bond

Cash

Surety Bond

Bonding Company Name

Street/P.O. Box

City

State

Zip

Phone Number

JAIL INFORMATION

Were you taken to jail?

If yes, where were you detained

E-MAIL COMMUNICATION

Computer access?

Internet access?

BY PROVIDING MY EMAIL BELOW, I AUTHORIZE AND CONSENT TO COMMUNICATE BY EMAIL. IN AUTHORIZING EMAIL COMMUNICATION, I UNDERSTAND IT IS MY RESPONSIBILITY TO NOTIFY PTI STAFF OF ANY CHANGES TO MY EMAIL ADDRESS. I ACCEPT THE LIABILITY AND RISKS ASSOCIATED WITH THE USE OF EMAIL AND UNDERSTAND PTI CANNOT ACCEPT RESPONSIBILITY FOR ANY EMAIL MESSAGES NOT RECEIVED BY OR FROM YOU, OR FOR ANY DELAY IN THE RECEIPT OR DELIVERY OF ANY EMAIL NOTIFICATIONS. PTI IS NOT RESPONSIBLE FOR LOSS OF MESSAGES AND OTHER CONSEQUENCES FROM THE USE OF ELECTRONIC COMMUNICATION.

Your personal Email Address

BACKGROUND INFORMATION

PLEASE CHECK ALL THAT APPLY:

Marital Status:

Married
Widowed
Divorced
Separated
Never Married
Cohabitating

Student Status:

Full time student
Part time student
Not attending
Completed GED
High School Diploma
Associate's Degree
Bachelor's or higher

Employment:

Full-time
Part-time
Unemployed
Disabled
Retired
DSS
Military Veteran

Personal income:

$0 to $4,999
$5,000 to $9,999
$10,000 to $19,999
$20,000 to $29,999
$30,000 to $39,999
$40,000 to $49,999
$50,000 Plus

Household income:

$0 to $4,999
$5,000 to $9,999
$10,000 to $19,999
$20,000 to $29,999
$30,000 to $39,999
$40,000 to $49,999
$50,000 Plus

Do you receive any of the following benefits?

Social Security

Unemployment

DSS Assistance

Veteran

Other

If Other, what?

Total amount of benefits received (per month): $

Do you have children?

If yes, how many?

Do you have an open case with DSS

If Yes, caseworker's name

SCHOOL/ EMPLOYMENT/MILITARY INFORMATION

SCHOOL INFORMATION

Name

Street

City

State

Zip

Current Grade

Last Grade Completed

Are you participating in any of the following?

Job Corp

Goodwill Training Program

Voc. Rehab

Other

If Other, what?

EMPLOYMENT INFORMATION

Name

Street

City

State

Zip

Phone Number

Start Date

Title/Position

Number of hours worked per week

Currently seeking employment?

MILITARY INFORMATION

Branch

Start Date

End Date

Type of Discharge

Special Training

PTI CHARGE INFORMATION

THIS INFORMATION IS NOT AN ADMISSION OF GUILT NOR IS IT ADMISSIBLE IN COURT FOR PROSECUTION OF THE CHARGE(S) PENDING AGAINST YOU.

Provide the ticket/warrant#(s) and charge information for the charge(s) you are applying to PTI on:

I received this charge in (if not sure please call the office at 843-958-1902)

Charleston County

Berkeley County

Was anyone arrested/charged with you (Co-Defendant)?

Co-Defendant Name

Status of Case

Pending

PTI

Dismissed

Convicted

Unknown

Co-Defendant Name

Status of Case

Pending

PTI

Dismissed

Convicted

Unknown

Why should you be given the opportunity to participate in PTI?

Since you PTI charge/arrest have you received counseling?

Counselor/Agency

How often do you attend?

Start Date

Last Appointment

CRIMINAL HISTORY INFORMATION

FALSE INFORMATION IN THIS SECTION WILL RESULT IN REJECTION OF YOUR APPLICATION OR TERMINATION FROM THE PROGRAM. THE APPLICATION FEE IS NON-REFUNDABLE.

LIST ALL PRIOR CHARGES AND/OR ARRESTS IN ANY STATE AND THE DISPOSITION OF THE CHARGE.

Date

State

Charge(s)

Disposition

Date

State

Charge(s)

Disposition

Date

State

Charge(s)

Disposition

Date

State

Charge(s)

Disposition

Date

State

Charge(s)

Disposition

Have you been charged with any crime since the incident for which you are applying for PTI?

Yes

Are you currently under investigation regarding any crimes?

Yes

Are you now or have you ever been on probation?

Yes

Have you ever served time in prison?

Yes

IF YOU ANSWERED YES TO ANY OF THE ABOVE QUESTIONS, PLEASE CONTACT THE PTI OFFICE TO DISCUSS YOUR ELIGIBILITY FOR THE PROGRAM.

CONTACT INFORMATION

I AUTHORIZE AND HEREBY CONSENT TO THE COMMUNICATION BETWEEN THE PRETRIAL INTERVENTION PROGRAM AND MY CONTACT PERSON(S) LISTED BELOW. THE COMMUNICATION MAY INCLUDE, BUT IS NOT LIMITED TO MY APPLICATION, PARTICIPATION IN THE PROGRAM, PROGRESS, AND DRUG TEST RESULTS.

PRIMARY CONTACT INFORMATION

Last Name

First

Middle

JR/III

Mailing Address

City

State

Zip

Home Phone

Cell Phone

Relationship to you

SECONDARY CONTACT INFORMATION (OPTIONAL)

Last Name

First

Middle

JR/III

Mailing Address

City

State

Zip

Home Phone

Cell Phone

Relationship to you

CHANGE OF ADDRESS/TELEPHONE NUMBER

(INITIAL) IF I CHANGE MY ADDRESS OR TELEPHONE NUMBER, I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO NOTIFY PRETRIAL INTERVENTION (PTI), THE COURT HANDLING MY PENDING CHARGE, AND THE BONDING COMPANY.

(INITIAL) I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO GET PERMISSION FROM MY PTI CASE MANAGER TO LEAVE THE STATE AFTER I HAVE APPLIED TO PTI. I UNDERSTAND THAT IF I USED A BONDING COMPANY, IT IS MY RESPONSIBILITY TO ALSO GET PERMISSION FROM THEM TO LEAVE THE STATE.

STATEMENT OF TRUTH AND RESPONSIBILITY

TO THE BEST OF MY KNOWLEDGE, I CERTIFY THAT ALL THE INFORMATION GIVEN ON THIS DOCUMENT IS TRUE AND ACCURATE. I HAVE NO PREVIOUS ARRESTS, CONVICTIONS, OR PENDING CHARGES THAT I HAVE NOT REVEALED IN FULL. I UNDERSTAND THAT ANY FALSE OR UNDISCLOSED INFORMATION MAY BE GROUNDS FOR MY REJECTION OR TERMINATION FROM THE PROGRAM. I UNDERSTAND THAT PTI WILL CONDUCT A CRIMINAL HISTORY INVESTIGATION. FURTHERMORE, I UNDERSTAND THAT FEES PAID TO THE PTI PROGRAM ARE NON-REFUNDABLE.

IMPORTANT: NO APPLICATION CAN BE FINALIZED WITHOUT ALL ITEMS BELOW SENT TO THE PTI OFFICE WITHIN 10 BUSINESS DAYS.

Copy of your recent picture ID
Copy of your Social Security Card [If you don’t have your SSC or a copy, please call our office for assistance -ASAP].

BY CHECKING THIS BOX, I CERTIFY THAT THIS IS MY APPLICATION AND I AGREE TO THE TERMS ABOVE.

DEFENDANT'S SIGNATURE

To submit application please initial and date.

Initials:

Date:

Verification Code: