Referral Form

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67th DISTRICT COURT
PROBATION DEPARTMENT
COURT ORDERED PROGRAMS
810-257-3177
Name:
Phone:
Offense:
Case No.:
Judge
You have been ordered to attend the following program: (Circle appropriate program)
SOS
o
Symposium on Substances Registration:
Registration will be held at 8:00 a.m.; class will begin promptly at 8:15 a.m. at which
time the doors will be locked. The program will conclude at 12:15 p.m.
o
Facts About Drugs Registration:
Registration will be held at 12:15 p.m.; class will begin promptly at 12:30 p.m. at which
time the doors will be locked. The program will conclude at 4:30 p.m.
o
Theft Intervention Program Registration:
Registration will be held at 12:15 p.m.; class will begin promptly at 12:30 p.m. at which
time the doors will be locked. The program will conclude at 4:30 p.m.
FAD
TIP
ALL CLASSES ARE HELD AT THE BURTON COURT LOCATION: 4094 Manor Drive, Burton,
Michigan. Please take note of the important information provided below:
 You must register for the class 48 hours from the date you were ordered to attend.
 You MUST PRE-REGISTER for the class by calling the telephone number listed above, as
class size is limited.
 You MUST pay the $80.00 registration fee prior to being registered for the class. This fee
must be paid at the location where you were sentenced.
 Your registration fee is non-refundable and non-transferable.
 You MUST give at least 72 hours notice AND pay a $20.00 re-schedule fee should you need
to reschedule your class.
 Once the program starts, no admittance will be allowed and no refund will be given for late
participants. You will be required to pay a $50 no show fee in order to re-register for another
class session should you fail to attend the class you were registered to attend.
ALL CLASSES ARE HELD AT THE BURTON COURT LOCATION: 4094 Manor Drive,
Burton, Michigan. Manor Drive is off Center Road between Bristol and Maple Roads.
From I-75 or US-23
I-75 and/or US-23 North to Bristol Road exit.
East on Bristol Road (approx. 4 miles).
South (right) on Center Road (1/2 mile).
Left on Manor Drive.
Burton Court is 2nd building on the right.
From I-475
I-475 North to Bristol Road exit.
East on Bristol Road (approx. 3 miles).
South (right) on Center Road (1/2 mile).
Left on Manor Drive.
Burton Court is 2nd building on the right.
From I-69
I-69 to Center Road Exit.
South on Center Road.
½ mile passed Bristol Road is Manor Drive.
Left on Manor Drive.
Burton Court is 2nd building on the right.
Original to Court / Copy to Probation / Copy to Defendant
Court Program Referrals 11/2012
67TH District Court
SOS, FAD, and TIP
COURT ORDERED PROGRAMS
Rules and Expectations
1. Be on time. Being on time shows respect for yourself and others. Check in will begin
fifteen minutes prior to the start of class. Once the program starts no admittance will
be allowed and no refund will be given for late participants.
2. Keep the program confidential. Participants in the program come from many
backgrounds. Some individuals may not want others to know about their
circumstances. If you know someone in the class, please respect their privacy just like
you’d like them to respect yours.
3. No Cross/Over Talk. Do not talk when someone else is sharing. Please be attentive
and show the individual respect.
4. Dress Conservative and do not wear any clothing with drug or alcohol
representations/advertisements. If you have clothing deemed inappropriate you will be
asked to leave and no refund will be given. No sagging pants, hats, caps, Halter
tops, short shorts, cut-off shorts will be allowed. For your comfort, it is
suggested that you dress in layers.
5. No food will be allowed during the program; however, you may bring a bottled water or
soda.
6. The more you participate the more you will gain. You can demonstrate participation by
being attentive, listening and providing feedback. Debate and even differences of
opinion are acceptable; however, what is not acceptable is name calling, harassing,
use of offensive language or talking about another member in a negative manner.
7. Cell phones and pagers are to be turned off while in group session. Leaving class to
check or make phone calls is NOT permitted.
8. Facilitator of the group reserves the right to ask anyone to leave that may become a
disruption to the class. If you are asked to leave, your fee will not be refunded and the
Court will be notified of an unsuccessful completion of the program.
9. No drugs or alcohol - Any one suspected of using or being under the influence may be
asked to leave the class and/or will be asked to submit to a PBT.
It is our hope that you will learn and take away from this program information that will
keep you and others safe from the use of alcohol and drugs.
Original to Court / Copy to Probation / Copy to Defendant
Court Program Referrals 11/2012
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