NEW ALBANY POLICE DEPARTMENT - New Albany, Ohio

Addendum A
Police Department
Diversion Request Form
Arresting Officer:
Defendant:
Incident Location:
Badge Number:
Incident Date:
Reason(s):
It is the opinion of the arresting officer that the above-mentioned defendant:
Should
Should not
be permitted to participate in a Diversion Program. The arresting officer has made this decision as a result of the following
circumstances;
It is the arresting officer’s recommendation that the following conditions be agreed upon for admission into the Diversion
Program.
Restitution to victim Completion of an alcohol/drug program
Completion of education Cooperation with local police agency
No use of checks or credit cards Family counseling
No offense of drug use or possession Steady employment
No offense of alcohol use or possession Other: (Please specify)
Signature of Arresting Officer
Date
PD-99-132
Revised December 22, 2010