Pride Integrated Services, Inc DUI and Traffic Education

Pride Integrated Services, Inc

DUI Program Rules And Regulations

1897 Palm Beach Lakes Blvd., Suite #121	4723 W. Atlantic Ave., Suite A-21	7619 Little Road, Suite 350	7064 Ft King Road
West Palm Beach, FL 33409	Delray Beach, FL 33445	New Port Richey, FL 34654	Zephyrhills, FL 33541
(561) 615-0767	(561) 278-4201	(727) 847-3411	(727) 847-3411

Name				Date
	Last Name	First Name	Middle Name

General Information

All fees must be paid prior to receiving a class schedule.

Failure to provide accurate information may result in additional program requirements and additional fees. Please be honest.

You must be alcohol and drug free for all appointments, including registration.

Per Administrative Rule, a DUI Program may refuse to enroll any person who is unwilling to comply with the rules and procedures of the program or who is unwilling to make a full disclosure for purposes of an evaluation.

Evaluation Requirements

Florida Statutes require a substance abuse evaluation of anyone enrolled in a DUI Program. This evaluation will be accomplished in part by having you complete questions concerning your drinking and/or drug use habits, questions about your personal life, and questions about your DUI history. If you have any questions about these forms, you may speak with an enrollment officer.

The DUI Program is State certified to provide DUI education programs and complete DUI evaluations. All Evaluators, SSS Evaluators and Instructors are State certified and are under direct Clinical Supervision. After completing paperwork, you will be given an appointment with a State certified Evaluator who will complete various forms that relate to your responses. A determination will be made about the level of education you will be required to attend as well as if referral to a DCF licensed or exempt by Statute) substance abuse treatment program will be required. There will be additional fees for this treatment as outlined in Florida Statutes.

90 Day Completion Requirement

Per Administrative Rule, any client who returns to the program more than ninety (90) days after the original enrollment to complete all or part of the program will have to re-enroll completely, including payment of all program fees.

The following requirements must be completed within the 90 day period:

1. Enrollment paperwork.

2. An evaluation with a State certified DUI evaluator.

3. An appropriate, mandated DUI education program.

If you fail to complete any part of these requirements within the 90 day time period, you will forfeit all fees and will not receive credit for any component completed. Per Administrative Rule, anyone entering 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 your DUI conviction is dropped or dismissed but your Administrative Suspension remains valid, you must still complete the DUI Program within 90 days. Failure to do so may result in a notice of cancellation to DHSMV and repayment of the full fee upon re-enrollment.

Class Completion Requirements

1. Attendance at all classes, on time and in sequence.

2. No alcohol or other drug use within 24 hours of class.

3. Completion of all assignments.

4. Payment of all fees.

If you receive a class schedule prior to completion of your evaluation, you will not receive a certificate of completion until you complete all components of the DUI Program.

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.

Confidentiality Requirements

The confidentiality of alcohol and drug abuse records is maintained by this office in accordance with Federal Law 42 CFR (Part 2) as well as State requirements. This program may not say to any outside person that you attend this program or disclose

1.The client consents in writing.

2.The disclosure is allowed by Court order.

3.Information regarding child abuse or neglect is obtained.

4. The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation. Information concerning any alcohol or drug client may not be used to criminally investigate or prosecute that client. Violation of confidentiality is a crime.

Program Fees

ALL Program fees are non-refundable. Complete Program fees, including reset fees, are posted in the enrollment area and appear below. If you come to your evaluation appointment or to any scheduled class under the influence of alcohol or other drugs, or are uncooperative or disruptive and asked to leave evaluation or class, you will be required to pay ALL FEES AGAIN, per Florida Statute. In cases of documented financial need, a fee reduction or payment plan may be available.

Grievance Procedure

Any individual who wishes to file a grievance regarding services may do so in writing within 30 days of the date of service delivery. Correspondence should be directed to the Director of the DUI program at the address listed on this form. Violations may be reported to DUI Programs Office - DHSMV@ (850) 487-1227. Additional Information Required prior to your evaluation

1. A copy of your arrest ticket which indicated B.A.L.

2. A copy of your probable cause/arrest affidavit.

3. If applicable, a copy of your court order.

4. One form of ID.

Level One Enrollment		Level Two Enrollment
$ 312.00	(Includes $5.00 DRI fee, $7.00 Online Fee, $15.00 driving record fee)	$ 457.00	Includes $5.00 DRI fee, $7.00 Online Fee, $15.00 driving record 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
$ 305 **	Any class reassignment more than 90 days after enrollment	$ 450 **	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
$ 305 **	Any evaluation reassignment more than 90 days after enrollment	$ 450 **	Any evaluation reassignment more than 90 days after enrollment


Evaluation not associated with DUI Program enrollment	$75.00
Transfer fee	$25.00
Administrative refund fee	$25.00
Processing referral to different treatment agency fee	$15.00
Duplicate certificate fee	$15.00
Per page copy fee	$01.00

**Includes $5.00 DRI fee and $15.00 driving record fee

I understand and have received a copy of these Rules and Regulations

Client Signature

Date

PRIDE DUI-740 (Rev.10/1/2020)

Palm Beach County Enrollments

Click Here for Pasco County Enrollments

(*) 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
VisaMastercardAmexOnly

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 $353.00. Level II registration for multiple offenses or previously attended DUI School is $518.00.

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 Pride Integrated Services, Inc are non-refundable, even if found not guilty of the DUI and the administrative suspension is invalidated.
That the client will not be admitted to class if under the influence of alcohol or drugs.
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

Pride Integrated Services, Inc

DUI Program Rules And Regulations

1897 Palm Beach Lakes Blvd., Suite #121	4723 W. Atlantic Ave., Suite A-21	7619 Little Road, Suite 350	7064 Ft King Road
West Palm Beach, FL 33409	Delray Beach, FL 33445	New Port Richey, FL 34654	Zephyrhills, FL 33541
(561) 615-0767	(561) 278-4201	(727) 847-3411	(727) 847-3411

Name				Date
	Last Name	First Name	Middle Name

General Information

All fees must be paid prior to receiving a class schedule.

Failure to provide accurate information may result in additional program requirements and additional fees. Please be honest.

You must be alcohol and drug free for all appointments, including registration.

Evaluation Requirements

90 Day Completion Requirement

The following requirements must be completed within the 90 day period:

1. Enrollment paperwork.

2. An evaluation with a State certified DUI evaluator.

3. An appropriate, mandated DUI education program.

Class Completion Requirements

1. Attendance at all classes, on time and in sequence.

2. No alcohol or other drug use within 24 hours of class.

3. Completion of all assignments.

4. Payment of all fees.

If you receive a class schedule prior to completion of your evaluation, you will not receive a certificate of completion until you complete all components of the DUI Program.

Transfer to Other DUI Programs

Confidentiality Requirements

1.The client consents in writing.

2.The disclosure is allowed by Court order.

3.Information regarding child abuse or neglect is obtained.

Program Fees

Grievance Procedure

1. A copy of your arrest ticket which indicated B.A.L.

2. A copy of your probable cause/arrest affidavit.

3. If applicable, a copy of your court order.

4. One form of ID.

Level One Enrollment		Level Two Enrollment
$ 312.00	(Includes $5.00 DRI fee, $7.00 Online Fee, $15.00 driving record fee)	$ 457.00	Includes $5.00 DRI fee, $7.00 Online Fee, $15.00 driving record 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
$ 305 **	Any class reassignment more than 90 days after enrollment	$ 450 **	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
$ 305 **	Any evaluation reassignment more than 90 days after enrollment	$ 450 **	Any evaluation reassignment more than 90 days after enrollment


Evaluation not associated with DUI Program enrollment	$75.00
Transfer fee	$25.00
Administrative refund fee	$25.00
Processing referral to different treatment agency fee	$15.00
Duplicate certificate fee	$15.00
Per page copy fee	$01.00

**Includes $5.00 DRI fee and $15.00 driving record fee

I understand and have received a copy of these Rules and Regulations

Client Signature

Date

PRIDE DUI-740 (Rev.10/1/2020)

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

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