Fillable Printable Form DTP-201 - Driver Training Programs Complaint Form - New York
Fillable Printable Form DTP-201 - Driver Training Programs Complaint Form - New York
Form DTP-201 - Driver Training Programs Complaint Form - New York
Program Name
Program Address
City State Zip Code
DRIVER TRAINING PROGRAMS
COMPLAINT FORM
www.dmv.ny.gov
PROGRAM
INSTRUCTOR
Use this form to register a complaint based on your experience with a driver training program, a driver training
instructor, or both.
o Driver Education Program
o Driving School
o Point and Insurance Reduction Program Delivery Agency
o Point and Insurance Reduction Program Sponsor
o Internet or Electronic Point and Insurance Reduction Program
o Driver Education Instructor
o Driving School Instructor
o Point and Insurance Reduction Program Instructor
o Pre-licensing Instructor
Mark the box or boxes below that apply to your complaint.
DTP-201 (6/15)
PAGE 1 OF 2
BUSINESS ID NUMBER CLIENT ID NUMBER
OFFICE USE ONLY
Complete this section if your complaint is about a driver training program.
COMPLAINT ABOUT A PROGRAM
COMPLAINT ABOUT AN INSTRUCTOR
Instructor’s Last Name
Instructor’s Address
City
Complete this section if your complaint is about a driver training instructor.
Instructor’s First Name
Name of the Program, School, Delivery Agency or Program Sponsor
COMPLAINT ABOUT A DRIVER TRAINING PROGRAM, INSTRUCTOR, OR BOTH
State Zip Code
Your M.I.
Your First Name
Mail or fax this ORIGINAL complaint form, with copies of
the documents that support your complaint, to:
New York State Department of Motor Vehicles
Driver Training Programs
6 Empire State Plaza
Albany NY 12228
Fax: (518) 473-0160
Your Signatureç
Date
PAGE 2 OF 2
DTP-201 (6/15)
Complaint Number
OFFICE USE ONLY
Your Address
Your Email Address
Write a full description of your complaint. If necessary, attach more pages.
Your Work Phone
( )
COMPLAINANT
Write the date or dates of this incident here:_____________________________________________________________
If there is a hearing to resolve this complaint, will you agree to testify?
o Yes o No
Attach the COPIES of letters or other documents that support your complaint.
If there is a hearing, I understand that the hearing will use a copy of this complaint and the other documents from me.
I understand that DMV also can provide these copies to the program or instructor named in this complaint. I understand
that this complaint and information about this complaint can be provided for a Freedom of Information (FOIL) request.
I understand that DMV will not provide any personal information about me, except my name, unless required to legally.
Your Last Name
Your Home Phone
( )
Suffix
City State Zip Code
You must complete this section. DMV does not accept anonymous complaints.
DESCRIPTION OF COMPLAINT
reset/clear
