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
)(
-
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
Page 1/2
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Form DPR-103 - Drinking Driver Program Application - New York PDF
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