MDOC Agent Referral Form CALL ETRS (800) 213-3877 to schedule your class or register online at www.etrsmichigan.com.Probation Agent(Required)Probation Agent Email(Required) Probation Agent Phone(Required)MDOC Client #(Required)MDOC Office(Required)Offense(Required)Participant Name(Required) First Last Date of Birth(Required)Participant Email(Required) Participant Phone(Required)Outpatient Programs AOD (Alcohol and Other Drugs) Outpatient Relapse Prevention Program (14 weeks $35/class): $490 AOD (Alcohol and Other Drugs) Outpatient Relapse Prevention Program (14 weeks $35/class) + Substance Abuse Evaluation: $490 Men’s Domestic Violence Orientation ($100) + 12-26 Weekly Sessions ($30/class) CBT/Positive Options Program: $240/8 sessions (Virtual Option) Economic Crime/Positive Options Program (Retail Fraud/Theft): $135/7.5hrs/4 sessions (Virtual Option) ETRS Educational Programs Alcohol Education Program - 2 Day: $225/13hrs (Virtual Option) Alcohol Education Program - 1 Day: $135/6.5hrs (Virtual Option) Anger Management Program - 2 Day: $225/13hrs (Virtual Option) Anger Management Program - 1 Day: $135/6.5hrs (Virtual Option) Drug Screens 4 Panel: $20 12 Panel: $45 Evaluations Substance Abuse Evaluation: $165 Driver’s License Appeal Evaluation: $375 Mental Health Evaluation: $225 Wayne County MDOC-Funded Programs - NO COST TO OFFENDER DDJR (Drunk Driver Jail Reduction / Adjudicated Release) Outpatient Relapse Prevention Program 14 weeks: GRANT FUNDED for MDOC 3rd offense OWI Felony Wayne Co. Residents Men’s Domestic Violence Orientation + 26 Weekly Sessions: GRANT FUNDED for Male MDOC Wayne Co. Residents with DV Charge If you are recommending a Wayne County MDOC-Funded Program, please upload the BIR below.Max. file size: 50 MB. If you are recommending a Wayne County MDOC-Funded Program, please upload a Compass Bar Chart below.Max. file size: 50 MB. Will you allow your participant to take a virtual class?(Required) Yes No - it must be in person By what date does the Participant need to finish the program(s) checked above? MM slash DD slash YYYY This field is hidden when viewing the formStatus Jetpack CRM - do not remove Δ
