MDOC Agent Referral Form

Probation Officer/Agent(Required)

Probationer Email(Required)

MDOC Client #(Required)

MDOC Office(Required)

Offense(Required)

Client Name(Required)

First Last

Date of Birth(Required)

Phone(Required)

Outpatient Programs (Virtual Options provided)

Outpatient Relapse Prevention Program - $100 Assessment and $30/week for weekly groups

Substance Abuse Assessment (Includes 4-panel drug screen) - $100

Drivers Licenses Appeal (includes 12-panel drug screen) - $350

Mental Health Evaluation - $200

Wayne County MDOC-Funded Programs - no cost to offender (Virtual Options provided)

Men’s Domestic Abuse – 1 Day Orientation and 26 weekly 90-min follow-up sessions - NO COST TO WAYNE CO. FELONY DV OFFENDERS

Wayne County Felony OWI Offenders - Outpatient substance Abuse Program - 14 weeks - NO COST TO WAYNE CO. FELONY OWI OFFENDERS

ETRS Programs (Virtual Options provided)

M20 Alcohol Weekend Education - $200 / 13.0 hrs

M21 Alcohol One Day Education - $120 / 6.5 hrs

M25 Anger/Aggression Management Weekend - $200 / 13.0 hrs

M26 Anger/Aggression Management One Day - $120 / 6.5 hrs

M27 Retail Fraud/Economic Crime One Day - $120 / 7.5 hrs

M28 CBT: Concentrate on Better Thinking/Positive Options - $200 (8 sessions, utilizes interactive journaling)

If you are recommending a Wayne County MDOC-Funded Program, please upload BIR below.

Max. file size: 50 MB.

Will you allow your probationer to take a virtual class?(Required)

Yes

No - it must be in person

Δ

Virtual Classes Are Coming!

Check the ETRS website in July to sign up for virtual classes.