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(*) denotes a required field |
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Copy Client Information Below if SAME |
Client First Name |
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Credit Card First Name |
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Client Last Name |
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Credit Card Last Name |
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Address |
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Credit Card Address |
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City |
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Credit Card City |
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State |
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Credit Card State |
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Zip Code |
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Credit Card Zip Code |
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County Where you Live, Work or Attend School |
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Payment Amount |
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Primary Phone |
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Credit Card Number
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How Did You Hear of Us? |
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Expiration Date (mmyy) |
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Email Address |
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Credit Card Verification Code |
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The following information is secured and required by the State to upload your data to the Florida Department of Highway Safety and Motor Vehicles: |
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Level I registration for first time offenders who have never attended DUI school is $348.00. Level II registration for multiple offenses or previously attended DUI School is $513.00.
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Gender |
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Date of Birth (mm/dd/yyyy) |
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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 Broward-Dade 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.
Untitled Document BROWARD TRAFFIC SCHOOL DUI Program Rules & Regulations | | General Information | Three (3) business days notice is required to reschedule an evaluation or a class without being charged a reassignment fee. Clients arriving late to class or an evaluation will be considered "No Shows" and will be assessed a reassignment fee. | Failure to complete the DUI Program, including the evaluation, classes and treatment, if required, will result in notification to the Department of Highway Safety and Motor Vehicles. | Program Requirements | The DUI Program consists of a clinical evaluation and classes. | | Clinical Evaluation: A structured psychosocial interview to determine the existence of a possible alcohol or other drug abuse problem. | | Class Requirements: First offenders (Level I) must complete 12 hours of classes, multiple offenders (Level II) must complete 21 hours of classes. | Fees must be paid in full. | Both the evaluation and classes must be completed within ninety(90) days of enrollment, regardless of whether your case is pending in court, due to the Administrative suspension, whether you are court-ordered or as a requirement to the DHSMV. | Reasons for having to re-enroll or reschedule at your expense: | | Failure to reschedule an evaluation or class without giving 3 business days notice | | Being late or absent for an evaluation or class | | Being under the influence of alcohol or other drugs | | Being disruptive or uncooperative | | Abandoning the Program before completion | | Failure to complete the evaluation and class within 90 days from enrollment | | Transfer to Other DUI Programs | You must attend a DUI Program in the county where you work, live or attend school. You may transfer your DUI requirements from or to this office to comply with this requirement. Failure to complete official transfer paperwork may complicate your completion of the DUI Program. | The transfer fee is $25.00. | Grievances | Any individual who wishes to file a grievance regarding services or treatment may do so in writing within 30 days of the delivery of the services. | Correspondence may be sent to 200 SE 6TH STREET, #502, Ft Lauderdale, Florida 33301. | Confidentiality | Certain data set forth herein is confidential and shall not be disclosed, except by your prior written consent court-ordered authorization or as otherwise prescribed in 42 C.F.R., Part 2(1990), reprinted in 42 U.S.C. 290dd-3/cc-3. | DHSMV Fee Schedule | All Fees are Non Refundable | Department of Highway Safety and Motor Vehicles | Enrollment Fees | DUI Level I $348.00 | DUI Level II $513.00 | | Includes evaluation, 12 hours of class, $15.00 State Assessment Fee, Driver Risk Inventory testing fee, $7.00 Online Registration Fee and Driver Record Fee. | | Includes evaluation, 21 hours of class, $15.00 State Assessment Fee, Driver Risk Inventory testing fee, $7.00 Online Registration Fee and Driver Record Fee. | | Evaluation Reassignment | Only two reassignments may be made without supervisor approval. | Within 3 business days notice - | | Within 90 days of enrollment - | After 90 days of enrollment - | No Charge | Level I | 1st Time $75.00 | 2nd Time $153.00 | $341 | | Level II | 1st Time $75.00 | 2nd Time $153.00 | $506 | Evaluation not associated with enrollment in the complete program $75.00 | | Class Reassignment | Only two reassignments may be made without supervisor approval. | Within 3 business days notice - | | Within 90 days of enrollment - | After 90 days of enrollment - | No Charge | Level I | 1st Time $40.00 | 2nd Time $75.00 | 3rd Time $153.00 | $341 | | Level II | 1st Time $60.00 | 2nd Time $120.00 | 3rd Time $238.00 | $506 | Any Level I reassignment for coming to DUI services under the influence $341 | Any Level II reassignment for coming to DUI services under the influence $506 | Standard and Ancillary | | | Other Fees | | First IID violation appointment for DUI offender | $25.00 | | Transfer Fee | $25.00 | - Client no shows, reports late or under the influence to the first IID violation appointment | $25.00 | | Administrative Refund Fee | $25.00 | Second IID violation or Initial Case Management appointment | $55.00 | | Returned Check Fee | $27.50 | - Client no shows, reports late or under the influence to the initial case management appointment | $55.00 | | Duplicate Certificate Fee | $10.00 | Second violation Case Management appointment | $25.00 | | Photocopy Fee per page | $0.50 | - Client no shows, reports late or under the influence to the case management appointment | $25.00 | | Urinalysis Fee | $40.00 | SSS Ignition Interlock review with Periodic Update This charge is not duplicated if the client misses the Periodic Update | $10.00 | | Blood Alcohol Test Fee | $25.00/$40.00 | Referrals to Treatment | | | Online Registration Fee | $7.00 | Initial Referral and within 21 days of initial referral - No Charge | $00.00 | | Photocopy Fee per page | $0.50 | Change Treatment Provider after 21 days of Initial Referral | $15.00 |
| | Treatment Verification/Reprieve Letter 77096 |
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| $10.00 | | | | | | | I understand and have received a copy of these Rules and Regulations. | | |
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Social Security Number (No Dashes) (If you have no SSN, Enter 000000000) |
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Florida Driver License # (If NO DL, Enter first initial of Last Name and 12 zeros) |
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Out of State Driver License # (Only if you have no Florida DL) |
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DL# State if Not Florida |
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Number of Previous DUI arrests PRIOR to the current one |
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Have you ever attended DUI school in the past? |
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State of Current DUI Arrest |
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The client has reviewed all statements made on this screen and agrees that they are true and correct.
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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.
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