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Pinal County Adult Probation Department Report Form

  1. Have you moved since your last visit?
  2. Are you actively serving or previously discharged from the U.S. Armed Forces, National Guard or Reservists?
  3. Do you receive financial assistance?
  4. Court payment submitted/current
  5. Are you in counseling or treatment?
  6. Is your license suspended?
  7. Have you had police contact?
  8. Have you violated any conditions of your probation?
  9. Community Restitution (Service) current?
  10. Within the last month I have had success in working toward my case plan by:
  11. I plan to address any problems in reaching my goals by:
  12. Goals I want to achieve within the next two to three months are:
  13. Triggers (People, places and things that could lead me to past behaviors are:
  14. People I look up to for help include:
  15. Questions for my probation officer
  16. By typing my name below, I HEREBY DECLARE that the above statements are true and that I am complying with the conditions of my probation. I understand that the information provided on this form can be used in any future court proceedings

    Seen by:

    Time Seen:

    Entered into APETS? Yes/No

  18. Leave This Blank: