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2. Hays Police Department Diversion Application Form
4. First Name *

   Please provide your full name.

5. MI*
6. Last Name*
8. Street Address*

   Please list your current address.

9. City/State*
10. Zip Code*
12. Daytime Phone Number*
13. Email Address*
15. Type of Offense*
    -- Select One --TrafficCriminalDUIOther
16. Date of Incident*
    Date of Incident
17. Case Number*
19. Offense(s) Description*
21. Have you had a prior diversion with the Hays Municipal Court:*

    1. Yes
    2. No
23. If yes, please indicate the approximate date and charge.
25. Can you have the Fines / Court Costs / Diversion fees paid for within 60 days of your court date:*

    1. Yes
    2. No
27. Do You Have a Commercial License?*

    1. Yes
    2. No
29. How would you like your diversion to be sent to you: *

    You also have the option to come in person to our office to obtain a diversion

    1. Mail
    2. Email

31. If this form is not completely filled out, a diversion will not be considered.

Leave This Blank:


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

    This field is not part of the form submission.

37. Submit

* indicates a required field