Referrals – Traffic Safety Association of Macomb County

Here you can make a guest referral, or login here, if you’ve been registered, to have your contact information pre-filled.

Referral

Please complete the form below and click send. Your referral will be processed within one business day. You will notified upon your client’s completion of the required classes. Please feel free to contact our office with any inquiries. You can find a course overview here. Please contact the office for information on pricing.

Referring Agency

Judge / Probation Officer Name

Agent Address(Required)

Street Address City State ZIP Code

Name of Referring Agent

Contact Email(Required)

Courses to be Taken(Required)

Level 1 – Defensive Driving Course (DDC Level 1)

Level 2 – Attitudinal Dynamics of Driving Course (ADD)

Forum for Alternative Theft-Offender Education (FATE)

Forum for Alternative Theft-Offender Education (Juvenile FATE)

Alcohol Highway Safety Program / Drug Awareness Program (AHSP Level 1)

Alcohol Highway Safety Program / Drug Awareness Program (AHSP Level 2)

MADD Victim Impact Panel (to occur immediately after AHSP Class)

Vaping Awareness Program (VAPE)

Youth-Education-Success (YES)

Anger Management Program (ANG)

Anger Management Program (Juvenile ANG)

THINK Program (THINK)

Driver Efficiency Evaluation Program (DEEP)

Community Service

Class Completion Deadline

MM slash DD slash YYYY

Reason for Referral

Case Number(Required)

Client Information

Name(Required)

First Last

Gender(Required)

Male

Female

Date of Birth(Required)

MM slash DD slash YYYY

Drivers License Number

Address

Street Address City State ZIP Code

Client Phone Number(Required)

Alternative Phone Number

Client Email(Required)

Special Instructions