- Form DPR-151 - DDP Fiscal Report - New York
- Form DS-21 - Interlock Device Installation Confirmation - New York
- Form DPR-152 - Drinking Driver Program Annual Enrollment Report - New York
- Form DPR-102 - Drinking Driver Program Instructor Application - New York
- Form DPR-104 - Drinking Driver Program Service Agreement - New York
- Form MV-1W - Withdrawal of Consent - New York
Fillable Printable Form DPR-103 - Drinking Driver Program Application - New York
Fillable Printable Form DPR-103 - Drinking Driver Program Application - New York
Form DPR-103 - Drinking Driver Program Application - New York
OFFICE
USE
ONLY
ACTION WANTED:
INSTRUCTIONS: Applicants must complete and send all materials listed here to the address on the bottom of page 2:
Drinking Driver Program Application (DPR-103)
Drinking Driver Program Service Agreement (DPR-104)
Drinking Driver Program Instructor Application (DPR-102) for each instructor.
Original
Amendment
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Address of Organizational Sponsor
New York State Department of Motor Vehicles
DRIVER TRAINING PROGRAMS
www.nysdmv.com
DRINKING DRIVER PROGRAM APPLICATION
DPR-103 (10/08)
*DPR-103*
Phone Number Extension
City
County
Address (Continued)
E-Mail Address
State
Zip Code
-
)(
Fax Number
-
Business ID Number for Agency
Agency Name (Municipality/Facility/School or Organization Sponsoring the Drinking Driver Program)
Contact Person Last Name
Suffix (Jr., Sr., etc.)
Contact Person First Name
Middle
Initial
Contact Person Title
PAGE 1 OF 2
SPONSORING AGENCY INFORMATION
Federal Employer ID Number or Social Security Number
Complete and mail to:
New York State Department of Motor Vehicles
Driver Training Programs
6 Empire State Plaza, Room 412
Albany, NY 12228
Authorized Signature Date Signed
Print Name Print Title
±
PAGE 2 OF 2
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Address of DDP Program Site
Phone Number Extension
City
County of Program Site
Address (Continued)
E-Mail Address
State
Zip Code
-
)(
Fax Number
-
Drinking Driver Program Name
Last Name of Drinking Driver Program Director
Suffix (Jr., Sr., etc.)First Name of Drinking Driver Program Director
Middle
Initial
Last Name of Drinking Driver Program Administrative Coordinator
Suffix (Jr., Sr., etc.)
First Name of Drinking Driver Program Administrative Coordinator
Middle
Initial
DRINKING DRIVER PROGRAM INFORMATION
DPR-103 (10/08)
OFFICE
USE
ONLY
Business ID Number for Program
reset/clear
