Review of the Nunavut Community Justice Program: Final Report

APPENDIX 5 - NUNAVUT COMMUNITY JUSTICE AGREEMENT FORM

DEPARTMENT OF JUSTICE DIVERSION AGREEMENT FORM

One copy to Justice Committee, one copy to person, one copy to parent if under 18

TO BE FILLED OUT BY RCMP OR CROWN COUNSEL

RCMP Detachment/Crown Office Field Line
File# Field Line
Contact Person Field Line Phone Field Line
Date Sent to Committee Field LineFax Field Line

Precharge Diversion
Court (Post-Charge)

Diversion Review by Court Date field Line

Name of Person field LineD.O.B Field Line
Address Field LinePhone Field Line

Offense(s) Field LineCriminal Code field Line

Summary of Offense(s) - Prosecutor Information Sheet Included

field Line

In the case of a young person, the parent or guardian has been informed on this
date Field Line that this matter will be diverted.

TO BE FILLED OUT BY JUSTICE COMMITTEE
This Diversion has been:

Accepted

Date set to see Person field Line
Not Accepted

Field Line
Coordinator or Chairperson

Field Line
Date

Justice Committee Field Line

Contact Person field Line Phone field Line Fax field Line

When Justice Committee decides to accept Diversion, fax page one back to the RCMP or Crown Counsel.

One copy to justice committee

TO BE FILLED OUT BY RCMP OR CROWN COUNSEL

Name of Person Field LineFile Number field Line

Offense(s) field Line

CIRCUMSTANCES OF THE OFFENCE(S) or attach 1624 notes or the Prosecutor’s Information Sheet and Victim Impact Statement if any.

field Line
Peace Officer's signature

field Line
Date

Community field Line

One copy to Justice Committee, one copy to person, one copy to parent if under 18

TO BE FILLED OUT BY RCMP OR CROWN COUNSEL

Name of Person Field Line File # field Line
Justice Committee Field Line Date field Line

AGREEMENT
I acknowledge responsibility for the offenses that resulted in this diversion. I have been advised of my right to seek advice from a lawyer. I understand the requirements of this agreement and agree to participate of my own free will. I understand the Justice Committee will report back to the RCMP and if I do not complete this diversion, the matter may proceed through court.

Field Line
Person

Field Line
Date

******INUKTITUT & INUINAQTUUN TRANSLATIONS to come******

TO BE FILLED OUT BY RCMP OR CROWN COUNSEL

Name of Person field LineFile # field Line

Justice Committee Field LineDate field Line

RCMP Detachment/Crown Office field Line Fax Field Line

TO BE COMPLETED BY JUSTICE COMMITTEE

This Diversion was:
Completed

Describe what happened on this Diversion.

field Line

Not Completed

Comments:

field Line

field Line
Coordinator or Chairperson

field Line
Date

When Justice Committee completes the Diversion, fax page four back to the RCMP or Crown Counsel.

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