The Center for Cognitive Education, LLC.

Killeen Location: 4200 E. Stan Schlueter Loop, Suite #F

Killeen, TX 76542

Questions: Web site:

Killeen Referral Form

Effective 1-3-18

DATE OF REFERRAL:______CLIENT NAME:______

REFERRAL SOURCE NAME/TITLE/CONTACT INFORMATION:

______

The Center for Cognitive Education offers programs/services with non-traditional hours (evenings/weekends). For information on services offered in other counties, please refer to our web site, , “Contact Us” section.

NOTE TO THE CLIENT: “Registration/ enrollment” for all programs is only completed during the Orientation schedule listed below. There is no need to call/ email to schedule an appointment. Just show up to the Orientation, be on time, have your Orientation payment, and this completed Referral Form.If you miss your scheduled Orientation date, just show up for the next scheduled Orientation. If you have any questions, please send an email to.

NOTE TO THE REFERRING AGENCY: This form provides the client necessary enrollment information: how/where to enroll; costs; what to expect. Please identify a date for the client to attend the Orientation, give the completed form to client, and instruct them to bring it with them when enrolling on the date you specified below. (Payment methods accepted: cash or money order. Checks, credit/debit cardsare not accepted).

EMAIL the completed Referral Form to: . Identify type of service, last name, and first initial in email header (i.e. BCSC: Doe, J.). You will be advised of Orientation attendance.

ORIENTATION for BIPP: 1st3rdWEDNESDAY of each month; 3:00pm- 4:30pm

Date to Attend: ______Orientation Cost: $45($25 Orientation/$20 workbook).

The Orientation involves: reviewing/signing specific program agreement & Intake paperwork; program overview; client being assigned to a permanent weekly class (class times vary); purchasing of program workbook.

Batterers Intervention and Prevention Program (BIPP):

Program Overview:BIPP is ONLY appropriate for offenses involving violence within an intimate partner relationship (husband/wife, boyfriend/girlfriend, ex-husband/ex-wife, etc). Focus is placed on taking accountability for the battering behavior with the goal of stopping future acts of violence. Accredited by TDCJ-CJAD as an approved BIPP provider.

Program Length/Cost: 24 sessions (minimum 36 hours); 1 ½ hour weekly class sessions; $30 per weekly class.

(Enrollmentfor the Cognitive Education (CEP) and Non- Intimate Partner Violence (NIPV)(anger management) programs is ONLY conducted at our Temple office location: 2027 S. 61st Street, Suite #123, Temple, Texas 76504. Orientation in Temple is held on a weekly basis on Monday’s 4:30pm. Orientation costs for the CEP & NIPV programs is $25. Weekly groups vary. Send questions to )