DUI Online Registration - North Central Florida Safety Council

North Central Florida Safety Council, Inc.

3710 NW 51st Street - Suite A Gainesville, FL 32606 (352) 377-2566 Fax (352) 377-3153

DUI Program Procedures

Your class and evaluation schedule will be provided to you. To complete the requirements of the DUI Program, you must complete the required number of scheduled classroom hours, complete the scheduled evaluation and complete the referral to treatment, if required to do so. Enrollment and successful completion of this program must occur after your most recent arrest, and within 90 days of your initial enrollment.

The following will be considered a breach of program procedures which may result in dismissal from the program, and may result in payment of the maximum Department approved reassignment fee:

A.	Attending class or evaluation after consuming alcohol or other drugs except as prescribed.
B.	Any incident of disruptive behavior.
C.	Any suggestive, revealing or otherwise inappropriate clothing that may detract from the learning environment.
D.	Tardiness to or absence from class or evaluation, including returning late from breaks.
E.	Failure or refusal to make a full and accurate disclosure of information, whether for purposes of an accurate evaluation, placement into the proper class, or refusal to enroll into the proper class.
F.	Failure to complete all requirements of the DUI Program.

No additional fee shall be charged if:

You contact the program at least five business days prior to the date that the class or evaluation was scheduled and ask to be reassigned for a work or education related conflict. You will be reassigned to the beginning of the next course. This can only be done twice within 90 days of the initial enrollment date.

You contact the DUI Program where you registered at least forty-eight hours after the date of the scheduled class or evaluation and ask to be reassigned for exceptional circumstances that are beyond the client"s control and unknown to the client at the time of enrollment, defined as natural disasters, serious illness or hospitalization requiring documented medical attention, or death in the client"s immediate family. Written documentation shall be required.

Transfer Policy And Fee

The refund for transfers to another DUI Program after enrollment, but prior to completion of the program, will be the balance of the program fee excluding the cost of services already received, the cost of DHSMV records, State assessment fee, DRI fee, and the standardized DHSMV approved $25.00 refund fee. The fee for the service being transferred will not be refunded until you successfully complete all components and treatment requirements at the other program.

Confidentiality Requirements

The confidentiality of alcohol and drug abuse records maintained by this program is protected by 42 U.S.C. sections 290dd-22 Federal laws and 42 C.F.R. Part 2 Federal regulations. Client information cannot be disclosed without the written permission of the client, unless (1) allowed by a court order, (2) made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation, (3) if the client commits or threatens to commit a crime either at the program or against any person who works for the program, or (4) client is suspected of child abuse or neglect.

Violation of the Federal law and regulations by the program is a crime. Suspected violations may be reported to the United States Attorney in the district where the violation occurs.

Federal law and regulations do not protect any information about suspected child abuse or neglect from being reported under the state law to appropriate state or local authorities.

Evaluation

The purpose of the evaluation is to determine whether the client"s use of alcohol and/or other drugs may subject the client to further future risk for driving under the influence. A referral to treatment is indicated if risk is determined. Failure to complete treatment may result in cancellation of the driving privilege by the Department of Highway Safety and Motor Vehicles. The cost of treatment is the responsibility of the client. The treatment referral may not be waived without a supporting "independent" evaluation conducted by an agency appointed by the court and with access to the original evaluation conducted by the DUI Program. The cost of this procedure shall be borne by the defendant. [F.S. 316.193 (5) ]

Completion Notification

The DUI Program will file the Student Status Report, HSMV 77057 with the DHSMV as required, and will provide other verifications as requested by the client, court, probation, or Department of Highway Safety and Motor Vehicles.

Refunds: ALL FEES ARE NON-REFUNDABLE!

The Program may provide for a refund in the event the client is directed to attend a DUI course in error, and can provide written proof from either the court, probation, or the DHSMV. Program Administrative approval is required.

Completion Requirements

Anyone enrolling into the DUI Program (voluntarily, court ordered or as a requirement of DHSMV) is required to complete the educational requirements and obtain an evaluation within 90 days of enrollment. If the DUI conviction is dropped or dismissed, but the Administrative Suspension remains valid, you must still complete the DUI program within 90 days.

Failure to complete the program within 90 days of the initial enrollment date may result in the cancellation of the driving privileges by the DHSMV and will result in payment of the full enrollment fee to re-enroll in the DUI program, including the class and evaluation.

If the client is referred to treatment, he/she must contact the treatment agency within 20 days of the date referred. Failure to make contact with the treatment agency within 20 days of the date referred and/or complete the required treatment may result in cancellation of the driving privileges by the DHSMV.

Grievance Procedure

Client complaints should be addressed in writing to the DUI Program. Please provide adequate and appropriate information regarding the nature of the complaint.

Please direct all treatment referral appeals to the sentencing court or to the Division of Driver License if prior to sentencing or after revocation period expires.

Fee Schedule

The DHSMV approved fees charged for the DUI Program are as follows

Level One Enrollment		Level Two Enrollment
$358.00	Evaluation and Class Full Program Fee (Includes $5.00 DRI fee, $7.00 Online Fee)	$523.00	Evaluation and Class Full Program Fee (Includes $5.00 DRI fee, $7.00 Online Fee)
Class Reassignment: Level One		Class Reassignment: Level Two
$40.00	First reassignment within 90 days of enrollment	$60.00	First reassignment within 90 days of enrollment
$75.00	Second reassignment within 90 days of enrollment	$120.00	Second reassignment within 90 days of enrollment
$153.00	Third reassignment within 90 days of enrollment	$238.00	Third reassignment within 90 days of enrollment
$351**	Any class reassignment more than 90 days after enrollment	$516**	Any class reassignment more than 90 days after enrollment
Evaluation Reassignment: Level One		Evaluation Reassignment: Level Two
$75.00	First reassignment within 90 days of enrollment	$75.00	First reassignment within 90 days of enrollment
$153.00	Second reassignment within 90 days of enrollment	$153.00	Second reassignment within 90 days of enrollment
$351**	Any evaluation reassignment more than 90 days after enrollment	$516**	Any evaluation reassignment more than 90 days after enrollment
Evaluations Other
$75.00	Evaluation Only (with DRI) not associated with class attendance		** Includes $5.00 DRI Fee
Miscellaneous
$25.00	First IID Violation appointment for DUI offender	$30.00	Returned check charge
$25.00	- Client no shows, reports late or under the influence to first IID appt	$25.00	Transfer fee
$55.00	Second IID Violation or Initial Case Management	$25.00	Administrative refund fee
$55.00	- Client no shows, reports late or under the influence to Initial Case Management appt	$15.00	Processing referral to different treatment agency fee
$25.00	Second Violation Case Management	$5.00	Duplicate certificate or verification of completion f
$25.00	- Client no shows, reports late or under the influence to the Case Management appt	$2.50	Fax copy fee per page
$10.00	SSS Ignition Interlock review with Periodic Update (This charge is not duplicated if the client misses the Periodic Update)	$1.00	Per page photocopy fee
Please Note: You will be charged the Full Program Fee for any reassignment or reenrollment and be required to reschedule and complete the ENTIRE program if the requirements have not been completed after 90 days from the date of the initial enrollment.
I have read, or have had read to me, and understand the above procedures. A copy has been provided to me.

Client Signature

Date

Witness Signature

Date

(*) denotes a required field

1. Client Information

2. Payment Information - CARDHOLDER's Name and Address

Copy Client Information Below if SAME

Client First Name

Credit Card First Name

Client Last Name

Credit Card Last Name

Address

Credit Card Address

City

Credit Card City

State

Credit Card State

Zip Code

Credit Card Zip Code

County Where you Live, Work or Attend School

Payment Amount **

Primary Phone

- -

Credit Card Number
VisaMastercardAmexDiscover

How Did You Hear of Us?

Expiration Date (mmyy)

Email Address

Credit Card Verification Code

The following information is secured and required by the State to upload your data to the Florida Department of Highway Safety and Motor Vehicles:

** Level I registration for first time offenders who have never attended DUI school is $367.85.
** If you have EVER Attended DUI School for Any Reason, registration for Level II is $537.38.
** Both include a $15.00 state fee, $7.00 online fee and either $9.85 or $14.38 2.75% AllPaid service fee for Level I or II, respectively.

Gender

3. Client Agreement

Date of Birth (mm/dd/yyyy)

The client named on this screen consents to the enrollment and participation requirements of the DUI program. The client also understands and agrees:

That all fees payable to North Central Florida Safety Council are non-refundable, even if found not guilty of the DUI and the administrative suspension is invalidated.
That a BAC test will be administered prior to every class.
That the program must be completed within 90 days of this enrollment.
That the client has reviewed and accepted the State Requirements and Fees below.

Additional State Requirements - Click Here to View

North Central Florida Safety Council, Inc.

3710 NW 51st Street - Suite A Gainesville, FL 32606 (352) 377-2566 Fax (352) 377-3153

DUI Program Procedures

The following will be considered a breach of program procedures which may result in dismissal from the program, and may result in payment of the maximum Department approved reassignment fee:

A.	Attending class or evaluation after consuming alcohol or other drugs except as prescribed.
B.	Any incident of disruptive behavior.
C.	Any suggestive, revealing or otherwise inappropriate clothing that may detract from the learning environment.
D.	Tardiness to or absence from class or evaluation, including returning late from breaks.
E.	Failure or refusal to make a full and accurate disclosure of information, whether for purposes of an accurate evaluation, placement into the proper class, or refusal to enroll into the proper class.
F.	Failure to complete all requirements of the DUI Program.

No additional fee shall be charged if:

Transfer Policy And Fee

Confidentiality Requirements

Violation of the Federal law and regulations by the program is a crime. Suspected violations may be reported to the United States Attorney in the district where the violation occurs.

Federal law and regulations do not protect any information about suspected child abuse or neglect from being reported under the state law to appropriate state or local authorities.

Evaluation

Completion Notification

Refunds: ALL FEES ARE NON-REFUNDABLE!

Completion Requirements

Grievance Procedure

Client complaints should be addressed in writing to the DUI Program. Please provide adequate and appropriate information regarding the nature of the complaint.

Please direct all treatment referral appeals to the sentencing court or to the Division of Driver License if prior to sentencing or after revocation period expires.

Fee Schedule

The DHSMV approved fees charged for the DUI Program are as follows

Level One Enrollment		Level Two Enrollment
$358.00	Evaluation and Class Full Program Fee (Includes $5.00 DRI fee, $7.00 Online Fee)	$523.00	Evaluation and Class Full Program Fee (Includes $5.00 DRI fee, $7.00 Online Fee)
Class Reassignment: Level One		Class Reassignment: Level Two
$40.00	First reassignment within 90 days of enrollment	$60.00	First reassignment within 90 days of enrollment
$75.00	Second reassignment within 90 days of enrollment	$120.00	Second reassignment within 90 days of enrollment
$153.00	Third reassignment within 90 days of enrollment	$238.00	Third reassignment within 90 days of enrollment
$351**	Any class reassignment more than 90 days after enrollment	$516**	Any class reassignment more than 90 days after enrollment
Evaluation Reassignment: Level One		Evaluation Reassignment: Level Two
$75.00	First reassignment within 90 days of enrollment	$75.00	First reassignment within 90 days of enrollment
$153.00	Second reassignment within 90 days of enrollment	$153.00	Second reassignment within 90 days of enrollment
$351**	Any evaluation reassignment more than 90 days after enrollment	$516**	Any evaluation reassignment more than 90 days after enrollment
Evaluations Other
$75.00	Evaluation Only (with DRI) not associated with class attendance		** Includes $5.00 DRI Fee
Miscellaneous
$25.00	First IID Violation appointment for DUI offender	$30.00	Returned check charge
$25.00	- Client no shows, reports late or under the influence to first IID appt	$25.00	Transfer fee
$55.00	Second IID Violation or Initial Case Management	$25.00	Administrative refund fee
$55.00	- Client no shows, reports late or under the influence to Initial Case Management appt	$15.00	Processing referral to different treatment agency fee
$25.00	Second Violation Case Management	$5.00	Duplicate certificate or verification of completion f
$25.00	- Client no shows, reports late or under the influence to the Case Management appt	$2.50	Fax copy fee per page
$10.00	SSS Ignition Interlock review with Periodic Update (This charge is not duplicated if the client misses the Periodic Update)	$1.00	Per page photocopy fee
Please Note: You will be charged the Full Program Fee for any reassignment or reenrollment and be required to reschedule and complete the ENTIRE program if the requirements have not been completed after 90 days from the date of the initial enrollment.
I have read, or have had read to me, and understand the above procedures. A copy has been provided to me.

Client Signature

Date

Witness Signature

Date

Social Security Number (No Dashes)
(If you have no SSN, Enter 000000000)

Florida Driver License #

Out of State Driver License #
(Only if you have no Florida DL)

DL# State IF NOT Florida

Number of Previous DUI arrests PRIOR to the current one

Have you ever attended DUI school in the past?

Yes

State of Current DUI Arrest

The client has reviewed all statements made on this screen and agrees that they are true and correct.

I Agree

Note: Payment Authorization may take up to a few minutes depending on your connection. To avoid being charged twice DO NOT abort the transaction, close the page or press the Process Payment button twice. When the authorization completes, you will be automatically taken to the Receipt Page.

Also Note -
You are making a payment to our agency using the services of AllPaid / GovPayNet. On your credit card statement, the name of this agency North Central Florida Safety Council will appear along with the letters GPS which is an abbreviation for their corporate name AllPaid / Government Payment Service, Inc.

Your IP is 3.139.234.124