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

          

• Court Order

• DOC-1615 – SPRITE Program Referral and Face Sheet

• DOC-2272 – Physician Recommendation

• DOC-2273 – Psychiatrist Recommendation (if youth on psychotropic meds.)

• DOC-1706 – SPRITE Questionnaire

• DOC-1760 – SPRITE Program Rules and Expectations Agreement

• 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).

• Social History

• Education Report

 

¨      3.  Schedule youth’s 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 .

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