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.  

MIDDLESEX & MONMOUTH COUNTIES – You will NOT be registered for the class unless you submit form 1.

1. 1. IDRC Intake
   2. IDRC Records Release Authorization
   3. IDRC Agreement to Schedule
   4. IDRC Client Selection of Affiliate

Spanish Forms

1. SSI para alcohol y otras drogas – Spanish
2. Declaración Autobiográfica – Spanish
3. Autobiographa – Spanish

Provider Lists by County

Affiliated Providers – Middlesex County
Proveedores Afiliados – Middlesex County
Affiliated Providers – Monmouth County
Affiliated Providers – Ocean County
Affiliated Providers – Atlantic County
Affiliated Providers – Bergen County
Affiliated Providers – Burlington County
Affiliated Providers – Camden County
Affiliated Providers – Cape May County
Affiliated Providers – Essex County
Affiliated Providers – Gloucester County
Affiliated Providers – Hudson County
Affiliated Providers – Hunterdon County
Affiliated Providers – Mercer County
Affiliated Providers – Somerset County
Spanish Providers Somerset/Hunterdon County
Affiliated Providers – Union County
Affiliated Providers – Warren County