Student Intervention Reintegration Program
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Public Consulting Group, Inc. (PCG), has been contracted by AdCare
Educational Institute of Maine with funding from the Maine CDC to
enhance the referral database and conduct an evaluation of the SIRP
program, which is being implemented across Maine. PCG developed this
web-based database to collect and house referrals in one secure place
for use by AdCare and community organizations throughout Maine. All
data will be kept safe and confidential by PCG.
Create Referral Form
Referral information is sent directly to the SIRP class coordinator.
Personal information from referrals are not recorded by Public Consulting Group (PCG).
Information About Youth
Any special conditions/accommodations/needs for youth to be engaged in SIRP?
Has parent been notified of Referral?
If No, please specify why not:
Please indicate which local community-based prevention organization you refer to for SIRP.
Is youth able to read and respond independently? (May be required to answer survey questions on electronic device.)
What prompted this referral?