Superior-26 (revised October 2017) STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS SUPERIOR COURT Adult Drug Court Referral Form *ALL FIELDS ARE REQUIRED - FORM WILL NOT BE PROCESSED IF INCOMPLETE* Referral Date: Name of Defendant: also known as Date of Birth: Referring Source/Attorney: Source/Attorney: Telephone Number Facsimile Number Pending Case Number and Type of Charge: Court Date: For : Physical Location of Defendant for Contact: Adult Correctional Institutions Division: Bail Status: Other: Street Address: City/Town: State: Telephone Number: Alternate Telephone Contact Number: Other Location Information: Prior or Current Crime of Violence if Known: Possession of a Controlled Substance Describe: Comments: This Completed Form Must be Emailed to: Rhode Island Adult Drug Court Attention: Kaitlin Swinson, Adult Drug Court Manager kswinson@courts.ri.gov For use by the Office of the Attorney General or Adult Drug Court Manager Only Eligible Ineligible American LegalNet, Inc. www.FormsWorkFlow.com