Step 1 of 4 25% Personal DataPlease fill out the following information about yourself. Fields with an asterisk (*) are required.Participant's Name* First Last Address* Street Address Address Line 2 City State ZIP Phone #*This will be your main contact number.Email Address* Enter Email Confirm Email Communication Options*Landline onlyInternet onlyI have both a landline and internetI don't have a landline or internet available Date of Birth* Sex*MaleFemaleHeight*Weight*Ethnicity*White AmericanBlack or African AmericanNative American or Alaska NativeAsian AmericanNative HawaiianOther Pacific Islander Employer's NameOccupation*Employer's Address Street Address Address Line 2 City State ZIP Description of Work EnvironmentPlease provide details of your work environment.ScheduleSundayMondayTuesdayWednesdayThursdayFridaySaturday Please enter the times in which you work. Example: "9-5pm"Monthly Household Income*Co-signer Name* First Last Co-signer Phone*Number of Dependents?*Have you had a DUI evaluation?*YesNoIf yes, what is your level?*Please bring a copy of your evaluation to installation.Have you completed treatment?*YesNoAttending Now Court InformationPlease fill out the following information about the court and your case. Fields with an asterisk (*) are required.Sentencing Court/Division*Judge*Case Number*Charge*Type*ProbationPre-TrialVolunteerRequired Length of Monitoring*Example: 30 daysProbation OfficerNamePhoneFax AttorneyNamePhoneEmail Have you been on SCRAM Monitoring before?*YesNoEmailThis field is for validation purposes and should be left unchanged.