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Fillable Printable Form DPR-152 - Drinking Driver Program Annual Enrollment Report - New York

Fillable Printable Form DPR-152 - Drinking Driver Program Annual Enrollment Report - New York

Form DPR-152 - Drinking Driver Program Annual Enrollment Report - New York

Form DPR-152 - Drinking Driver Program Annual Enrollment Report - New York

Students Re-entered
More Than Once
Drop Notices Issued
Students Transferred
into Program
Students Referred
for Evaluation
Other Drugs
Students Retained
for Treatment
Students Dropped
Students Re-entered
(Drinking Driver Program Name) (DDP Location Code/ID Number)
Alcohol
Other Drugs
Jan. - March April - June July - Sept. Oct. - Dec. Total
JANUARY 1 THROUGH DECEMBER 31, _______ REPORT YEAR
DRINKING DRIVER PROGRAM (DDP)
ANNUAL ENROLLMENT REPORT
Driver Program Regulation
www.dmv.ny.gov
DPR-152 (3/15)
Complete and return to:
New York State Department of Motor Vehicles
Driver Program Regulation
6 Empire State Plaza, Room 412
Albany, New York 12228
SUMMARY OF REFERRALS FOR EVALUATION/TREATMENT
Courses Started
(# of Session Ones)
Student Names on Rosters
Students Actually
Reporting to Class
Alcohol
(Signature of DDP Director)
(Date)
(Print Name of DDP Director)
รง
0
0
0
0
0
0
0
0
0
0
0
0
reset/clear
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