Order to Attend Panel formTABLE OF CONTENTS -- NHTSA Home
appendix seven
Immediately after the sentence is pronounced, a court clerk or other designated person should inform the offender verbally and in writing of the date, time, and place of the panel to be attended. This form should be developed in triplicate: one copy for the offender, one for the panel coordinator and one for the court.
NAME_____________________________________ DOB________________ DL# _____________________
YOU HAVE BEEN SENTENCED TO ATTEND THE VICTIM IMPACT PANEL FOR INTOXICATED DRIVERS
Date_________________________ Time___________________________
Place _________________________________________________________________________________
Address_______________________________________________________________________________
Rescheduling is NOT permitted except in case of extreme emergency.
In that case, call (Name and phone #)________________________________________________________
The Panel will begin promptly at __________P.M. If you have not registered and are not seated by this time, you will not be admitted.
Failure to attend
(or reschedule in the event of emergency) will be a violation of your sentence
and may result in
_____________________________________________________________________________________.
Children under the age of ____________ will not be admitted. You (may/may not) bring a family member with you.
DRINKING OR OTHER DRUG USE PRIOR TO ATTENDANCE IS STRICTLY PROHIBITED.
You are required to bring a fee of $__________ in cash or money order to cover expenses of the Victim Impact Panel presentation.
_________________________________________________________
Signature
of Offender
_________________________________________________________
Signature
of Judge, Clerk or Probation Officer
The panel coordinator may alphabetically type names from the Orders to Attend onto this form.
Victim Impact Panel Sign-In Sheet
Today's Date: _________________________
Name (filled in by coordinator)_______________________________________________________________
Date of Birth (filled in by coordinator)_________________________________________________________
Drivers License # (filled in by coordinator)______________________________________________________
Signature (Signed by person attending the panel)_________________________________________________
Case No. (filled in by coordinator)____________________________________________________________
Name (filled in by coordinator)_______________________________________________________________
Date of Birth (filled in by coordinator)_________________________________________________________
Drivers License # (filled in by coordinator)______________________________________________________
Signature (Signed by person attending the panel)_________________________________________________
Case No. (filled in by coordinator)____________________________________________________________
Name (filled in by coordinator)_______________________________________________________________
Date of Birth (filled in by coordinator)_________________________________________________________
Drivers License # (filled in by coordinator)______________________________________________________
Signature (Signed by person attending the panel)_________________________________________________
Case No. (filled in by coordinator)____________________________________________________________
The signed sign-in sheets should suffice for court-ordered compliance. However, some judges/probation departments may require additional verification. Attendance certificates can be filled out and signed in advance in order to save time. Have offenders pick up their attendance certificates after the panel.
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This is to verify that (coordinator fills in )______________________________________________________ attended a Victim Impact Panel on (Date)____________________ and completed the required evaluation forms.
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dallas, texas certificate
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