Mentor Enrollment Form

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La Porte County Veterans Treatment Court Logo


Jeffrey Thorne, Judge
La Porte County Superior Court 3

Richard Buell, Executive Director
La Porte County Community Corrections

Stephen T. Eyrick, Chief Probation Officer
La Porte County

Roxann Justus, Director
La Porte County Drug & Alcohol Program

Jerry Montgomery, Treatment Provider

Carissa Smith, Community Representative

Thomas Thate, Captain
Chief of Detectives City of La Porte 2

George Watkins, Veterans Services Officer
La Porte County

Kurt R. Earnst, Deputy
La Porte County Public Defender’s Office

Heath Haferkamp
La Porte County Administrative Captain
Deputy Patrols

Ashley Wright, Case Manager
La Porte County Public Defender’s Office

Lauran Olson
Veteran Justice Outreach Specialist

Catherine Breitweiser-Hurt, Deputy Prosecutor
La Porte County

Tyra Walker, Director of Treatment Services
La Porte County Jail

Royce Williams
Michigan City Assistant Police Chief



If you would like you can download and print out the form below and mail it to the following:

Veterans Treatment Court
c/o Agnes Meer Project Coordinator
La Porte County Superior Court 3
809 State Street, Suit 104A
La Porte, IN 46350

Fill out the online form below. No information is saved.

Download Enrollment Form

Fields marked with an ( * ) are required

Veterans Court

  • MM slash DD slash YYYY
  • Availability

    During which hours are you available for mentoring assignments? (Please note, availability is not only for in-person meetings but also phone communications with mentee). Please mark each time frame according to your daily availability.
  • Military Service

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Please note: In most cases, only veterans with Honorable or General Discharges will be considered for the mentoring program. If you received a General Discharge or other, please provide a few brief details pertaining to the discharge.
  • (If you had more than one, please include all applicable)
  • Were you deployed during your time in active duty? If so please list all deployments and approximate dates.
  • Did you or do you receive services from the US Department of Veterans Affairs?
  • General Questions

  • Other Skills and Qualifications

  • Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports.
  • Summarize any previous volunteer experience.
  • Emergency Contact Info

  • Agreement and Electronic Signature

    By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a mentor, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal. Additionally, by submitting this application I understand I am consenting to a criminal background check. (Please note, individuals with felony convictions, any convictions for crimes of violence or individuals with any pending criminal cases will not be eligible to serve as a mentor). All information will be kept strictly confidential.
  • (First letter of your first name followed by last four digits of your SSN)
  • Our Policy

    It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual orientation, age, or disability.

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