Get Brains At Risk Program

The Brains At Risk Program is designed to enhance education and awareness regarding traumatic brain injury linked to driving choices. This guide provides step-by-step instructions to help users complete the referral form accurately and efficiently.

Follow the steps to successfully complete the referral form.

1. Click the ‘Get Form’ button to access the referral form and open it in the online editor.
2. In Section One, begin by filling in the BAR Referral ID Number and the date clearly. Ensure that the information is accurate as it is for office use.
3. Indicate whether an interpreter will attend by checking the appropriate box. Subsequently, enter the referred individual's name, docket number, mailing address, city, state, zip code, phone number, and date of birth. Also, select the offense from the options provided.
4. Complete the court and probation officer/magistrate's name. If necessary, add any other supervising agency for notification, ensuring to provide the corresponding fax number.
5. Proceed to Section Two. The referred individual should print their name and read the terms thoroughly. Ensure they initial next to each agreement regarding the release of contact information, program fee, additional fees for postponed seminars, and notifying BIA-MA of any changes.
6. In the consent section, the referred individual must provide their signature to agree to the terms outlined, along with the date of signing.
7. After all fields are completed, review the form to confirm accuracy. Users can then choose to save changes, download, print, or share the completed form.

Complete the Brains At Risk Program referral form online today to ensure timely processing and enrollment.