Alcohol Education or DUI/DWI classes are designed for those who may have an issue with using alcohol which has lead to an arrest or charge of “driving under the influence” and/or” driving while intoxicated”.
Please fill in all the form fields as accurately as possible. If there is missing or incomplete information, it may cause a delay in processing your referral information.
You have two options to submit a referral to us.
- It can be printed, completed and faxed to 410-220-0730. ATTN: Ms. Wise
- Fill in the form to the right and submit it through our secure website
For questions about completing this form or inquiries about our services please call 410-617-8026 x 0 or email email@example.com and a program representative will reply within 1 business day.