How
to Make a SPRITE Referral
To
Complete the Forms by Computer, follow the directions below.
To print the entire
SPRITE Referral Packet and complete by hand, please
click here.
Please print this page to use as a
referral checklist.
¨
1.
Make an initial phone call to the SPRITE Director Jo Mercurio
at 608.288-3356.
¨
2.
Upon
confirmation of an opening for the youth, fill out the following
documents and send the packet 14 days prior to the session start date.
Send the information to:
SPRITE Program
Attn:
Jo Mercurio
2909 Landmark Place, Suite 104
Madison,
WI 53713
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Court Order
-
DOC-1615 SPRITE Program Referral and Face Sheet
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DOC-2272 Physician Recommendation
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DOC-2273 Psychiatrist Recommendation (if youth on psychotropic
meds.)
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DOC-1706 SPRITE Questionnaire
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DOC-1760 SPRITE Program Rules and Expectations Agreement
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DOC-2196 Emergency Medical Authorization for a Minor (signed
by parents/guardian)
-
DOC-2245 SPRITE Program Interagency Agreement (include name of
Insurance Co. & ID number).
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Social History
-
Education Report
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3.
Schedule youths interview date with the SPRITE Director. All youth are
required to have an interview either in person (if possible) or by
telephone.
¨
4.
Provide youth with
information needed before coming to the SPRITE Program.
¨
5. The
county agency is responsible for transportation of the youth to and from
the SPRITE Program. County youth must arrive at the SPRITE House
between 10:00 a.m. and 12:00 noon on the first day of the session.
¨
6.
Graduation begins at 10 am on the last day of the session .