Skip to Main Content

Loading

Loading

Create a Website Account - Manage notification subscriptions, save form progress and more.

Website Sign In

Search

Government
Services
Community
Business
Transparency
How Do I...

Home
Form Center

Form Center Module

Form Center

Search Forms:

Search Forms Select a Category

All Categories
ABC Wastewater
Area Plan Commission
Assessor Forms
CASA
Community Service Forms

CP-Training
Health Department
HR Forms
Juvenile Alternatives
Payment Center
Probation

Prosecutor's Office
Sheriff's Department
Superior Court 3
TCPWQ
TEMA Forms
WEBMASTER

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Community Service Form

Sign in to Save Progress

This form has been modified since it was saved. Please review all fields before submitting.

Steps

1. Step One This section is complete This section is incomplete
2. COMMUNITY SERVICE FORM This section is complete This section is incomplete
3. EMPLOYER INFORMATION This section is complete This section is incomplete
4. EMERGENCY CONTACTS This section is complete This section is incomplete
5. COURT INFORMATION This section is complete This section is incomplete

Step One

Disclaimer
Information submitted on this form will be sent using email. Please do not include social security numbers, Drivers License numbers, or any other personal information other than the requested information on the form.
Continue

COMMUNITY SERVICE FORM

Last Name*
First Name*
Middle
Date of Birth*
Date of Birth
mm/dd/yyyy
Email Address*
Where we may contact you
Phone Number*
Where we may contact you
Address*
Include Apt # if applicable
City*
State*
Zip Code*
Hair Color:*
Eye Color*
Height
In Feet and Inches
Weight
In pounds (lbs.)
Gender*
Race*
Marital Status
US Citizen?
1. YES
2. NO
Veteran?
1. YES
2. NO
Current Student?
1. YES
2. NO
Level of Education Completed
Driver's License?
1. YES
2. NO
Continue |Go Back

EMPLOYER INFORMATION

Employer
Employer Phone #
Include Area Code
Address
City
State
Zip Code
Weekly Hours
Hourly Wage in Dollars
Disabled?
1. YES
2. NO
Monthly Income in Dollars
Continue |Go Back

EMERGENCY CONTACTS

First Name*
Last Name*
Relationship*
Phone Number*
Address*
Include Apt# if Applicable
City*
State*
Zip
First Name
Last Name
Relationship
Phone Number
Address
Include Apt# if applicable
City
State
Zip
Continue |Go Back

COURT INFORMATION

Case/Cause Number
Date
Date
First Name
Last Name

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
Submit | Go Back

* indicates a required field

Home Page

Contact Us

20 North Third Street
Lafayette, IN 47901
Commissioners 765-423-9215

Connect With Us

Helpful Links

Home
Site Map
Accessibility
Copyright / Policy

/QuickLinks.aspx

Government Websites by CivicPlus®

[]