MAIN OFFICE

80 Conover Rd.
Marlboro, NJ 07746
800-705-HOPE (4673)

12 Hour IDRC Program Forms

This program has been developed specifically in response to the COVID-19 pandemic.   

Please complete all forms listed under your county and click to submit each.  They must be completed as fully as possible.  If you would like to receive a copy of the forms you must include your email address.  

IDRC Curriculum Manual can be downloaded HERE

MIDDLESEX COUNTYYou will NOT be registered for the class unless you submit forms 1 though 4.

    1. SSI for Alcohol and Other Drugs
    2. Autobiographical Statement
    3. Autobiography
    4. Informed Consent for Telehealth Services
    5. IDRC Records Release Authorization
    6. IDRC Agreement to Schedule
    7. IDRC Client Selection of Affiliate
    8. Payment Link

MONMOUTH COUNTYYou will NOT be registered for the class unless you submit forms 1 though 5.

    1. SSI for Alcohol and Other Drugs
    2. Autobiographical Statement
    3. Autobiography
    4. Informed Consent for Telehealth Services
    5. NJ DUI/Refusal Legal Requirements – Monmouth County
    6. IDRC Records Release Authorization
    7. IDRC Agreement to Schedule
    8. IDRC Client Selection of Affiliate
    9. Payment Link ~ Square Up is supported on Google Chrome, Mozilla Firefox, Apple Safari, Microsoft Edge, Opera, and UCWeb UC browsers

OCEAN COUNTYYou will NOT be registered for the class unless you submit forms 1 though 4.

    1. SSI for Alcohol and Other Drugs
    2. Autobiographical Statement
    3. Autobiography
    4. Informed Consent for Telehealth Services
    5. IDRC Records Release Authorization
    6. IDRC Agreement to Schedule
    7. IDRC Client Selection of Affiliate
    8. NJ DUI/Refusal Legal Requirements – Ocean County

Provider Lists by County

Affiliated Providers – Middlesex County
Proveedores Afiliados – Middlesex County
Affiliated Providers – Monmouth County
Affiliated Providers – Ocean County
Affiliated Providers – Somerset County
Affiliated Providers – Union County
Affiliated Providers – Essex County
Affiliated Providers – Hudson County
Affiliated Providers – Bergen County

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