You May Not Have To Go To Court in Person. Make Your Choice and Follow The Directions Below

You may not have to go to court in person. Make your choice and follow the directions below.
ONLINE CHOICE
A STOP HERE AND GO TO
WWW.JUDICI.COM If you marked box B you must read and sign the
PLEA, PAY, AND/OR APPLY FOR SUPERVISION following:
MAIL-IN CHOICES B, C, & D I plead guilty and waive my right to a hearing.
B Plead guilty, Pay Ticket Amount, Conviction is reported to the Secretary of State, Place your
signature in the box at right & mail to the address below*. DO NOT APPEAR IN COURT.
x ______________________ ______________
YOUR SIGNATURE DATE
C AVOID CONVICTION on Your Driving Record, Plead Guilty, Register for the Driver Safety Program. Pay Ticket Amount and an Additional $30.00
for Traffic School Supervision. Place your signature in the first paragraph on page (2) and below, and fill out the "registration form" on page (2) and
mail to the address below*.
D Plead Not Guilty and Request A Hearing Before A Judge. Follow the directions on the reverse side of your ticket and
DO NOT USE THIS DOCUMENT.
DO NOT APPEAR IN COURT UNTIL YOU RECEIVE A TRIAL DATE.
READ ALL INSTRUCTIONS FOR MAIL-IN CHOICES

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1.UNLESS your complaint is marked “YOU MUST APPEAR IN COURT”, 4. If you are found to be ineligible for the Driver Safety Program a conviction will be
you have choices. Read them carefully and put an X in appropriate reported to the Secretary of State and the $30.00 FEE WILL NOT BE REFUNDED.
boxes above, follow the instructions and mail this form to
the address below*.
2. All certified checks and money orders are made payable to “CLERK OF 5.Your receipt, driver’s license, or bond card will be mailed to you once you mark
THE CIRCUIT COURT”, DO NOT SEND CASH OR PERSONAL CHECKS. the appropriate box above, and after your payment is received and processed.
If you posted cash bail with the officer when stopped, you will owe Keep the goldenrod copy of your ticket until your driver’s license or bond card is
an additional $30 if requesting supervision. returned to you.
3. To register for the Driver Safety Program and avoid a conviction on

your driving record, mark box C, place your signature on the first *Mail Form To: Alexander County Circuit Clerk
paragraph on page (2) and below and fill out the “Registration Form”.
2000 Washington Ave.
Cairo, IL 62914
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ELIGIBILITY *YOU MUST NOT HAVE BEEN PLACED ON COURT SUPERVISION FOR A TRAFFIC TICKET ISSUED
REQUIREMENTS: IN THE 12 MONTHS PRIOR TO YOUR CURRENT TICKET.
*YOUR CURRENT TICKET MUST INDICATE THAT NO COURT APPEARANCE IS REQUIRED.
*VIOLATORS UNDER THE AGE OF 18 AT THE TIME OF THE VIOLATION ARE NOT ELIGIBLE FOR ONLINE SUPERVISION OR MAIL IN
SUPERVISION AND MUST APPEAR IN COURT WITH A PARENT TO REQUEST SUPERVISION.
SPECIAL NOTES: *IF YOU DO NOT COMPLETE THE SAFETY SCHOOL OR SEND PROOF OF COMPLETION, A CONVICTION WILL BE REPORTED TO
TO THE SECRETARY OF STATE.
*CDL DRIVERS SHOULD CONTACT THE ALEXANDER COUNTY STATES ATTORNEY AT (618) 734-0408 TO DISCUSS THE
ELIGIBILITY FOR COURT SUPERVISION.
My name is (Print)_____________________________________________________ Signature___________________________________________________________
Address________________________________________________________________ City__________________________ State______________ Zip_____________
IF YOU HAVE ANY QUESTIONS REGARDING TRAFFIC SAFETY SCHOOL, please E-mail: drivesafe@shawneecc.edu
If you have questions regarding your ticket, please contact the Alexander County Circuit Clerk at 618-734-0107.
PAGE 1 REVISED 2/26/2020

APPLICATION FOR COURT SUPERVISION AND DRIVER SAFETY PROGRAM
COUNTY OF ALEXANDER
DRIVER SAFETY PROGRAM INSTRUCTIONS

• This form also requires that you plead guilty and request supervision either online or by mail.
• WHEN COMPLETE, either e-mail this form to alexcocls19@gmail.com or mail it to:
Alexander County Circuit Clerk

2000 Washington Ave.
Cairo, IL 62914
• TO REGISTER: Complete the registration form below.

• THE DRIVER SAFETY PROGRAM: Your class assignment form will be mailed to you in approximately 30 days. It is not necessary to call the Driver Safety Program
office to schedule a class time. SOME CLASS SITES HAVE LIMITED OR RESTRICTED SCHEDULES. Your request will be honored, if possible, or the closest possible
change will be made. If you are unable to attend your scheduled class, IMMEDIATELY CALL THE DRIVER SAFETY PROGRAM OFFICE AND RESCHEDULE. (You may
reschedule one time at no charge with Shawnee College only). Call no later than the date stamped on your class assignment form, if you miss your class you must
reschedule a new class and pay $10. REMEMBER: Traffic Safety School must be completed before the court supervision completion date which will be 120 days
from THE DATE OF PLEA AND PAYMENT.
• OUT OF AREA MOTORISTS
If you are eligible to attend a Defensive Driving Course (4 hours) in your area and have met eligibility requirements you will still need to enroll in our program for tracking purposes.
YOU ARE RESPONSIBLE FOR ANY ADDITIONAL FEES THEY MAY CHARGE IN YOUR AREA.
*NOTE: PLEASE CHECK WITH YOUR STATE IF YOU ARE A CDL DRIVER QUESTIONS REGARDING:
CLASS LOCATIONS: DRIVER SAFETY PROGRAM
1. Massac County (Metropolis) Shawnee Community College
PO Box 517 Anna, IL 62906
2. Pulaski County (SCC Main Campus) E-MAIL TO: drivesafe@shawneecc.edu
3. Union County (Anna) OFFICE HOURS: 9:00 a.m. to 3:00 p.m.
4. Jackson County (Carbondale) Monday - Thursday
5. Out of area motorist Friday - 8:00 A.M. - 4:00 P.M.
Phone inquiries: 618-833-8435.
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REGISTRATION FORM FOR IF YOU REGISTER FOR THE PROGRAM YOU WILL NOT NEED TO APPEAR
THE DRIVER SAFETY PROGRAM IN COURT. The Driver Safety Program Office will report to the court when you complete
the class. No driving conviction will be reported to the Secretary of State.
Put an X in front of your choice.
☐ Massac Co. – Evening

LAST NAME
☐ Jackson Co. – Wed. Evening
☐ Jackson Co. – Sat. Morning FIRST NAME
M
SEX
F
M.I.
☐ Pulaski Co. – Thurs. Evening
☐ Union Co. – Wed. Evening STREET NUMBER AND NAME
☐ Union Co. – Sat. Morning
☐ Out Of Area Motorist* APT # CITY STATE ZIP
☐ Online
Additional fee(s) may apply when registering for Online Class.
DATE OF BIRTH DRIVERS LICENSE NUMBER STATE
AREA CODE DAYTIME PHONE TICKET NUMBER TICKET DATE
EMAIL ADDRESS
PAGE 2 REVISED 2/26/2020

You May Not Have To Go To Court in Person. Make Your Choice and Follow The Directions Below

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You may not have to go to court in person. Make your choice and follow the directions below.

MAIL-IN CHOICES B, C, & D I plead guilty and waive my right to a hearing.

READ ALL INSTRUCTIONS FOR MAIL-IN CHOICES

3. To register for the Driver Safety Program and avoid a conviction on

*YOUR CURRENT TICKET MUST INDICATE THAT NO COURT APPEARANCE IS REQUIRED.

My name is (Print)_ Signature_______

Address________________________________________________ City State Zip_

PAGE 1 REVISED 2/26/2020

DRIVER SAFETY PROGRAM INSTRUCTIONS

Alexander County Circuit Clerk

• TO REGISTER: Complete the registration form below.

☐ Massac Co. – Evening

AREA CODE DAYTIME PHONE TICKET NUMBER TICKET DATE

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