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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 Number |
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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 $365.20. ** If you have EVER Attended DUI School for Any Reason, registration for Level II is $536.39. ** Both include a $15.00 state fee, $7.00 online fee and either $13.20 or $19.39 AllPaid service fee for Level I or II, respectively.
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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 C.O.R.E Program, Inc. 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.
CORE
Comprehensive Offender Rehabilitation & Education Program
Serving the 19th Judicial Circuit St Lucie, Martin, Indian River, & Okeechobee Counties
www.coreprogram.org
Fort Pierce
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800 Virginia Ave, #4 |
Fort Pierce, Fl 34982 |
772-465-9204 Phone |
772-460-1751 Fax |
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Stuart
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905 Johnson Ave |
Stuart, Fl 34994 |
772-286-7333 Phone |
772-223-0903 Fax |
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Vero Beach
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1412 Old Dixie Hwy |
Vero Beach, Fl 32960 |
772-567-1282 Phone |
772-567-1336 Fax |
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Okeechobee
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406 NW 3rd Street |
Okeechobee, Fl 34972 |
863-763-1985 Phone |
863-763-4616 Fax |
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Student Information Sheet
GENERAL INFORMATION
- Enrollment in the DUI Program (voluntarily, court ordered or a requirement of DHSMV) requires completion of the educational requirement and an evaluation within 90 days of enrollment. If the DUI conviction is dropped or dismissed but the Administrative suspension remains valid, completion is required. Failure to complete the DUI program will result in a notice of cancellation to DHSMV. Full registration fee will be charged for re-enrollment. Students must enroll in the county of which they live, work, or go to school.
- SPECIAL CONSIDERATION WILL BE PROVIDED TO HANDICAPPED CLIENTS UPON REQUEST.
- Any person who is under the influence of alcohol / drugs, unwilling to comply with the rules / procedures of the program or is unwilling to make full disclosure for the purpose of the evaluation will be denied enrollment into the program.
- Any person who is believed to have consumed alcohol, illegal drugs, abused prescription medication, arrives late for an appointment or disrupts an evaluation / class will be denied participation in program services. Breathalyzer tests may be administered. Any indication of substance use will result in cancellation of the evaluation / class and a reschedule fee will be assessed with Administrative Rule 15A-10.
- Appropriate dress required: shirt and shoes.
- All fees paid are NON-REFUNDABLE even if a client is found not guilty and the Administrative Suspension is invalidated.
CLASS ATTENDANCE
- Level I Classes: (12 hours in length)
- Level II Classes: (21 hours in length / Multiple Offenders)
EVALUATION / CLINICAL INTERVIEW
The State of Florida, Administrative Rule 15A-10 requires that all DUI students have an in depth clinical evaluation / interview and complete treatment if required. The purpose of the clinical evaluation is to identify those students who may need assistance with a substance abuse problem or are at risk for a repeat offense.
Evaluations are generally 1 hour in length. Clients are responsible for providing their ARREST AFFIDAVIT. Tape recorders are not permitted. Children are not permitted during the evaluation.
- NO Reschedule FEE will be charged if student contacts program within 5 business days prior to class or evaluation to R / S.
- If student contacts program within 48 hours after scheduled class / evaluation and asks to be rescheduled due to exceptional circumstances the student will be rescheduled at NO FEE. Exceptional Circumstances: natural disaster, death in client's immediate family, serious illness requiring hospitalization of the client, documentation required.
CONFIDENTIALITY OF ALCOHOL && DRUG ABUSE PATIENT RECORDS
The confidentiality of alcohol and drug abuse patient records maintained by this program is protected by Federal laws and regulations. Generally, the program may not say to a person outside the program that a patient attends the program, or disclose any information identifying a patient as an alcohol or drug abuser unless:
(1) The patient consents in writing (2) The disclosure is allowed by a Court Order (3) The disclosure is made to medical personnel in a medical emergency or to a qualified personnel for research, audit, or program evaluation (4) The patient commits or threatens to commit a crime either at the program or against any person who works for the program.
Violation of Federal law and regulations by a program is a crime. Suspected violations may be reported to the United States Attorney in a district where the violation occurs.
Federal law and regulations does not protect any information about suspected child abuse or neglect from being reported under State Law to appropriate State or Local authorities.
(See 42 U.S.C. 290dd-22 for Federal laws and 42 C.F.R. Part 2 for Federal regulations)
TRANSFER POLICY
A Client who enrolled in one program and requests to transfer to another, either a Florida licensed program or similar in another state or country shall be charged the State approved transfer fee. Any fees refundable will be paid within 30 days of receipt of written documentation of successful completion of the receiving program.
GRIEVANCES
A grievance regarding services or treatment may be submitted in writing within 30 days of the delivery of services. Correspondence may be directed to the Executive Director or to the Board of Directors of the CORE Program, Inc., 905 Johnson Ave, Stuart, FL 34995.
DUI Program Fees
DUI Enrollment Fee: Level 1
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$352.00 |
(includes DRI fee, State Assessment Fee and D/L Printout) |
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DUI Class Rescheduling Fees: Level 1
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$40.00 |
1st reassignment within 90 days of enrollment |
$75.00 |
2nd reassignment within 90 days of enrollment |
$153.00 |
3rd and subsequent reassignment within 90 days of enrollment |
$250.00 |
Under the Influence to class / evaluation |
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DUI Evaluation Rescheduling Fees: Level 1
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$75.00 |
1st reassignment within 90 days of enrollment |
$153.00 |
2nd and subsequent reassignment within 90 days of enrollment |
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Out of State / Other Fees
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Classes not associated with DUI Program enrollment |
$225.00 |
Classes only Level I |
$385.00 |
Classes only Level II |
$80.00 |
Evaluation not associated with DUI Program enrollment(Includes $5.00 DRI Test) |
$35.00 |
Out of State Processing Paperwork Fee |
$150.00 |
Out of State Processing for State of Illinois |
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Miscellaneous Fees
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$25.00 |
Transfer fee (DUI/IID/SSSP) |
$25.00 |
Administrative Refund Fee |
$15.00 |
Processing referral to different Treatment Agency |
$10.00 |
Duplicate Certificate |
$15.00 |
Florida Motor Vehicle Record |
$1.00 |
Copies per page |
$5.00 |
DRI Testing (DUI/IID/SSSP) |
$15.00 |
State Assessment (DUI/SSSP) |
$20.00 |
FTC - File Reopen Fee |
$25.00 |
Failure to provide Arrest Affidavit and / or Out of State Driving Record |
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DUI Enrollment Fee: Level 2
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$517.00 |
(includes DRI fee, State Assessment Fee and D/L Printout) |
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DUI Class Rescheduling Fees: Level 2
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$60.00 |
1st reassignment within 90 days of enrollment |
$120.00 |
2nd reassignment within 90 days of enrollment |
$238.00 |
3rd and subsequent reassignment within 90 days of enrollment |
$410.00 |
Under the Influence to class / evaluation |
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DUI Evaluation Rescheduling Fees: Level 2
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$75.00 |
1st reassignment within 90 days of enrollment |
$153.00 |
2nd and subsequent reassignment within 90 days of enrollment |
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IID (Ignition Interlock) Fees
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$25.00 |
IID first violation appointment |
$25.00 |
IID first violation missed appointment |
$55.00 |
IID Case Management appointment 2nd/3rd violation |
$55.00 |
IID missed Case Management appointment 2nd/3rd violation |
$45.00 |
IID 2nd violation monthly appointment |
$45.00 |
IID 3rd violation monthly appointment |
$25.00 |
IID 2nd/3rd violation missed monthly appointment |
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SSSP Fees
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$297.00 |
Enrollment (includes records, state assessment and screening fee) |
$24.00 |
FDLE Record |
$15.00 |
Florida Motor Vehicle Record |
$55.00 |
Periodic Update / Reschedule Periodic Update |
$55.00 |
SSSP Case Monitoring appointment |
$10.00 |
IID for SSSP Clients |
$75.00 |
Reschedule Initial Psychosocial |
$75.00 |
Appeal Appointment - No Psychosocial |
$150.00 |
Appeal Appointment - Psychosocial |
$75.00 |
Reapplication within 6 months |
$5.00 |
DRI Testing |
$25.00 |
Screening |
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By checking the box below, I acknowledge that I understand and have received a copy of these Program Rules and Fees.
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Social Security Number (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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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 C.O.R.E. Program, Inc will appear along with the letters GPS which is an abbreviation for their corporate name AllPaid / Government Payment Service, Inc. |
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