ASSIGNMENT TO Driver Intervention Program

Date
Case No.
Name
Address
City
State
Zip
Phone
BAC
Prior Arrests

As condition of obligation to the court, you are directed to attend and comply with the 4-Day residential Driver Intervention Program Sponsored by D.I.P. THE COURT WILL BE NOTIFIED IMMEDIATELY of your failure to attend AS SCHEDULED or failure to comply with the rules of Driver Intervention Program resulting in further action by this court.

2017 SCHEDULE
**REPORTING TIME: 5:30 P.M. THURSDAY EVENING**


Southfield Quality Inn
26111 Telegraph Road
Southfield, MI 48033

Check the session you will be attending:

Judge
Court

Probation Officer
Probation Phone Number

•• TO ENROLL AS PER ORDER OF THE COURT ••
• Call (888) 347-1394 within 72 hours of receiving this form between the hours of 9 a.m. – 5 p.m. Mon.-Fri. •
• Rescheduling Fee $50.00 •
•• All Major Credit Cards Accepted ••

CONSENT TO ASSIGNMENT

I understand consent to assignment also includes the following:
The registration fee of $395.00 (includes housing and meals, private room available for $525.00) will be paid in full by money order or certified check (no personal checks) to Driver Intervention Program prior to the Driver Intervention Program I am scheduled to attend. I understand there will be no refunds. I also understand it is mandatory that I be dropped off at the Above Location: I will not be allowed to leave the hotel or make any phone calls. There is no Thursday evening meal served. There are no visitors allowed at the program at any time.
I authorize the above named court to release information contained on this sheet to the Driver Intervention Program.
I understand that reports of my attendance and meeting other conditions of this assignment will be forwarded to the referring court. This authorization will expire when conditions of this assignment have been met.

Defendant
Date

DOWNLOAD the form HERE

 

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