Referrals

To refer an offender to a CS Courses class, please complete the form below and select the appropriate class. The offender must provide a current contact phone number and email address. Upon receipt of the referral, the CorrectiveSolutions case coordinators will contact the offender and assist them in scheduling and paying for their class.

If your agency has a referral code, please include that code in the appropriate box. If you have any questions, or need additional assistance, please call 866-286-1106.

Please complete the form below

First Name

Offender

Last Name

Offender

Participant Email Address

Offender

Phone Number

Offender

(###)

###

####

Address 1

Offender

Address 2

City

State

Zip Code

Class

Referral Code

Agency Email Address

Enter email address to receive a copy of the completion notice.

Agency Phone Number

Referrals

Please complete the form below

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