ADP Online Registion Form

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*Your First Name:

*Your Last Name:

*Your Current Address: Apt. #:

*Your City: *Your State: *Your Zip Code:

*Your Telephone #: (###-###-####)

*Your E-mail address:

Check if you are a UW-Milwaukee student

*Citation # :

*Court Date :

UWM Police Citation

City of Milwaukee Police Citation

Other Police Agency ---- Name:

 

Questions, comments, concerns:

**** You must be at least 18 years of age to qualify for the Alcohol Diversion Program***

*Required information inorder for form to submit.

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