2025 IDP Client Intake Package

  • Intoxicated Driver Program Intake Package

    **All information is mandatory and confidential. This enrollment process may take approx. 20-30 mins to complete**

  • **PLEASE NOTE, THIS PROGRAM IS FOR KENOSHA COUNTY RESIDENTS ONLY. IF YOU ARE NOT A KENOSHA COUNTY RESIDENT, CONTACT OUR OFFICE FOR MORE INFORMATION (262) 658-8166**

  • I am a Kenosha County resident.*

  • INTAKE INFORMATION 

    Please complete and submit these forms ONLY if you are prepared to pay for and schedule your assessment within 48 hours.

    Submitting the intake package will NOT impact your driving privileges. You MUST also pay for, schedule, and complete your assessment in order to maintain or restore compliant status (license eligibility) with the Department of Transportation.

    If you are not able to complete the full payment and scheduling process at this time, please come back and complete this intake package when you are able to make the full payment.

    Fees range from $350-$450, please contact our office at (262) 658-8166 for more information.

    We will NOT hold documents for more than 48 hours.

  • Assessment fees range from $350-$450 based on your compliance with the Department of Transportation. Are you prepared to pay for and schedule your assessment within 48 hours of submitting this intake package?*
    • Social History Information 
    • Sex*
    • Birthdate*
       - -
    • Format: (000) 000-0000.
    • Is it OK to leave a message on your voicemail?*
    • Military*
    • I am on supervision (probation/parole)*
    • Do you need an interpreter?*
    • Do you have health insurance (including State of WI insurance/T19)?*
    • Living Arrangement:*
    • Employment Status:*
    • Education:*
    • Support Group Attendance - How many times have you attended groups in the last 30 days?*

    • Work History

    • Are you currently employed?*
    • Have you ever been employed previously (former employer)?*
    • Are you currently participating in counseling, classes, groups, or treatment for alcohol or other drugs?*
    • Have you ever participated in counseling, classes, groups, or treatment for alcohol or other drugs (former provider)?*

    • Family Information

      All information is mandatory and confidential.
    • Are you currently, or have you ever been married or lived with a significant other?*
    • Do you have any children?*
    • Please Indicate Annual Household Income:*
    • Are you the Head of Household?*
    • Date*
       - -

  • Information about the Intoxicated Driver Program (IDP)

    The Department of Transportation (DOT) requires that a Driver Safety Plan (DSP) be developed at the Hope Council during your assessment. Based on the findings of your assessment, you will be required to attend either education or treatment, so you must be prepared for either. 

    **THE ASSESSMENT IS JUST THE 1ST STEP**

     Education Referral

    • If you are referred to education, you will be required to attend classes at Gateway Technical College (GTC).

    • You must enroll and pay in full for the required classes within 10 business days of your assessment.

    • The current rates are $311.70 for Group Dynamics and $444.40 for Multiple Offenders and are subject to change.

    • If you do not register within 10 business days, GTC will place you into non-compliance with the DOT, and you may lose your driving privileges. 

    Treatment Referral                                                                  

    • A list of approved area treatment providers is included in this intake package; however, you may choose any Wis. Stat. DHS 75 licensed provider.

    • If you are referred to treatment, you must inform the assessor of the provider you have selected during your assessment appointment.

      • Failure to provide this information during your assessment appointment may result in additional fees.

      • There is NO EXCEPTION to this requirement, the Wis-DOT will not allow the submission of plans without the provider information.

    County Funding 

    County funding may be available to offset the cost of treatment if you do not have health insurance that covers substance use treatment and you meet income restrictions. To determine eligibility, you must bring all the following documents to your assessment appointment. These documents are only required if you do not have health insurance.

    • A current Wisconsin photo ID

    • Proof of residency within the last 30 days (e.g., a utility bill showing your current address)

    • Pay stubs from all employment/income this year; “income” includes unemployment pay stubs and/or Social Security Disability or Social Security Supplemental Income pay stubs.

  • I understand that I will be required to attend either education at Gateway Technical College or engage in counseling as part of my plan and that my assessment findings determine the referral, not my personal preference.*
  • If my Driver Safety Plan includes EDUCATION, I understand that I will be required to enroll at Gateway Technical College within 10 business days and that all fees are due in full to Gateway when I enroll. Current rates are $311.70 for Group Dynamics and $444.40 for Multiple Offenders class.*
  • If my Driver Safety Plan includes COUNSELING, I understand that the provider information must be submitted to the WI-DOT during the assessment appointment.*
  • Date*
     - -

  • 2025 Intoxicated Driver Program Fees

    IDP Assessment for Kenosha County Residents....................... $350.00
    Non-Compliance Fee....................................................... $100.00
     

    Applied when appointment is not made within 14 days of conviction, failure to complete Driver Safety Plan (DSP) within one (1) year, or fully comply with recommendations of the DSP.

    		  
    Plan Extension.............................................................. $100.00
      Request must be submitted by treatment provider 14 days prior to plan expiration and approved by Hope Council. Extension of up to 4 months may be granted in order to complete treatment.  
    Re-Assessment / DSP Amendment....................................... $250.00
     

    Applied when a client’s active DSP requires re-assessment or modification due to missing or omitted information including treatment provider information, or a significant change in the plan of care.

    		  

    Out of State / Additional State(s) Package add........................

    		 $250.00
      If you have open/unresolved drug or alcohol driving violations from a state other than Wisconsin, or on a license not issued by the Wis-DOT, please contact our office for more information.   
    Returned Check.............................................................

    $40.00
    Refund Processing Fee....................................................

    $25.00

     Rescheduling and Cancellation Policy

    • A $100 fee applies to all assessment appointments canceled with less than 48 hours notice and to all no-shows.

    • An appointment is considered canceled if you are more than 15 minutes late, or if you are present but will not be seen due to a determination made by Hope Council staff.

    • All fees must be paid in full before an appointment can be rescheduled.

    Assessment Appointments Policy

    • The Hope Council will refuse assessment services to any individual appearing for their appointment under the influence of any mood-altering substance not used as prescribed. If the assessor suspects impairment, the appointment will be considered canceled and must be rescheduled.

    • Your full attention is needed during the assessment, and ALL clients deserve privacy. Therefore, NO ONE else, including children or infants, is allowed to wait in the lobby or be present during your assessment. Failure to adhere to this rule will require you to reschedule.*

     *See Rescheduling and Cancellation Policy listed above.

  • Date*
     - -

  • IDP Approved Providers

    The WI-DOT requires that you select your provider and inform your assessor during your appointment. Intoxicated Driver Program clients with health insurance should contact their insurance company to determine which providers are covered. 

     Approved Providers:

    Aalto Enhancement Center

    8503 75th St. Kenosha 

    		 (262) 654-9370

    Accepts insurance,  Self-pay

     
    ASAP (Addiction Services & Pharmacotherapy)

    3825 39th Ave. Kenosha

    		 (262) 946-5752

    Accepts insurance

     
    Agape Recovery Center 201 N. Pine St. Burlington (262) 767-0441

    Accepts insurance, Self-pay

     
    CleanSlate

    7201 Green Bay Road. Kenosha

    		 (262) 842-0149

    Accepts insurance, Self-pay

     
    Comprehensive Treatment Center   7991 Sheridan Rd. Kenosha (855) 963-3228

    Accepts insurance, Self-pay

     
    Hope Council 6103 39th Ave. Kenosha (262) 658-8166 

    Self-pay

     
    Interconnections S.C. 920 60th St. Kenosha (262) 767-0441

    Accepts insurance

     
    PSG (Professional Services Group) 2108 63rd St. Kenosha (262) 652-2406

    Accepts insurance

     
    Rogers Behavioral Health  9916 75th St.  Kenosha (262) 942-4000

    Accepts insurance, Self-pay

     
    West Grove Clinic 1400 75th St. Kenosha 262-909-6008

    Accepts insurance,  Self-pay

     

    Hope Council does not recommend or endorse any specific providers. Providers included on this list have agreed to provide monthly reports and updates directly to Hope Council.

    Important: If you select a provider who is not on this list, you are responsible for ensuring monthly progress reports and updates are provided to Hope Council in order to maintain plan compliance. 

  • Date*
     - -

  • IDP Client Rights, Grievances, Appeals & Consent

    Client Rights

    As a participant in the Intoxicated Driver Program (IDP), you have rights under Wisconsin Statutes s. 51.61, DHS 94, DHS 62.15, and DHS 75, including:

    The right to be informed of the nature and purpose of the assessment and Driver Safety Plan (DSP).

    • The right to participate in the development of your DSP.
    • The right to review and request amendments to your DSP.
    • The right to confidentiality of your records, consistent with state and federal law.
    • The right to appeal assessment findings or DSP recommendations.
    • The right to file a grievance if you believe one of your rights has been violated.

    Grievance Procedure

    You (or someone acting on your behalf) may file a grievance within 45 days if you believe any of your rights have been violated.

    I acknowledge that the Client Rights & Grievance Procedure for Community Services has been provided to me in hard copy and explained to me verbally, and that I understand the process for filing a grievance.

    Appeal Procedure

    If you believe your assessment findings are incorrect or your Driver Safety Plan (DSP) is inappropriate, follow the steps below. Detailed appeal procedure information will be provided, reviewed, and acknowledged at the time of assessment.

    • Step 1 – Contact your Assessor within 5 days.
    • Step 2 – Submit a written appeal to the Executive Director within 10 days.
    • Step 3 – If upheld, you may request a second assessment at another approved agency (at your expense).
    • Step 4 – If still unresolved, appeal to the Kenosha County Human Services Behavioral Health Manager Jeni Parkinson, 8600 Sheridan Rd, Kenosha, WI 53143.
  • Date*
     - -
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