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E-Toke (Marijuana Intervention)

alcohol and drug education program

Students referred for other drug intervention will complete the online marijuana assessment, E-Toke. Following completion of the assessment, students must complete two follow-up appointments with a staff member.

E-Toke (Other Drug Intervention) Registration Form

IMPORTANT: Please be certain of your referral before proceeding. This registration form is to be used for E-Toke (Other Drug Intervention) registration only. To register for E-Toke, please complete the form below. Upon completion of registration, you will be contacted by ADE staff with instructions on how to access and complete the online assessment.

PLEASE NOTE: A $50 administrative fee will be charged to your account for all programs that are a result of a disciplinary or court sanction. If you miss a class or appointment, you must reschedule, and you will be charged for the missed class/appointment in addition to your re-scheduled class/appointment. If this is a self-referral, there is no fee. For questions about the E-Toke program, please contact us at 617-552-0243.

All fields are required for registration.

Your Full Name 

E-mail Address 

Local Address

Class Year

Phone

Referred By

"Complete By" Date

For each day of the week, please indicate your availability for a one-hour follow-up meeting to be held AFTER you complete the online assessment. If you are unavailable on a particular day, simply do not select a time frame.


Monday between          and  
Tuesday between         and  
Wednesday between    and   
Thursday between        and  
Friday between         and  

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