On referral by a public or private agency or mental health professional, application for admission to a RICA may be made by: The parent or guardian of a child or adolescent under 18 years old; An adolescent, if the adolescent is 16 years old or older; or A State or county agency that has custody of a child or adolescent, with the signed consent of the parent or guardian or in accordance with a court order. The admission application shall be on a form prescribed by the Administration and shall include: The name, date of birth, sex, legal domicile, and present residence of the applicant; A statement based on clinical evaluation by a mental health professional that the applicant has a long term and severe mental disorder and is in need of residential treatment; and A recent history of the applicant's psychiatric or psychological treatment, educational or special educational services, and involvement with community agencies. Available medical records and psychiatric or psychological evaluations describing the applicant's mental disorder and need for residential treatment shall be attached to the admission application. The referring agency or mental health professional shall be responsible for assuring that appropriate written consent is obtained so as to permit that all required completed application materials may be sent to the RICA.