Form Dr 2643 PDF Details

Navigating the process to regain driving privileges in Colorado after a suspension due to alcohol or drug violations involves several important steps, one of which includes the completion of a Level II Drug and Alcohol Education and Treatment Program. This requirement is formalized through the DR 2643 form, a crucial document provided by the Colorado Department of Revenue's Division Of Motor Vehicles. Designed to ensure that individuals meet their obligations for reinstatement, this form serves as an affidavit of enrollment in the approved program, tracking progress, and ensuring compliance with its conditions. It requires detailed information, including the participant's name, the agency's details administering the program, and estimated completion dates, all aimed at keeping the DMV informed about an applicant's journey through the program. The form underscores the importance of not just attending, but also completing the program as stipulated, highlighted by the need to report any noncompliance which could jeopardize an applicant's driving privileges further. It also outlines the steps to be taken in case of noncompliance, essentially linking the successful recovery and education of individuals with their ability to legally drive again, making the DR 2643 a key piece in the recovery and reinstatement puzzle.

QuestionAnswer
Form NameForm Dr 2643
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesaffidavit enrollment level, colorado form enrollment, dr2643, dr2643 form

Form Preview Example

DR 2643 (03/10/15)

COLORADO DEPARTMENT OF REVENUE

Division Of Motor Vehicles

Driver Control Section, Room 164

Phone: (303) 205-5792

www.colorado.gov/revenue

Afidavit of Enrollment

Level II Drug and Alcohol Education and Treatment

This Section to be Completed and Returned to The DMV Driver Control Section

Name

Date of Birth

Colorado PIN

Date of Admission

Agency Name

Agency ID

Track Assigned

Estimated Date of Completion

Signature of Authorized Staff Member

Date

Agency’s Phone Number

1.As a condition for the reinstatement of driving privileges, I must complete a Level II alcohol and drug education and treatment program. I understand that the agency providing this service is required to report any noncompliance with the terms of such program and that a report of noncompliance may result in cancellation of my driver’s license and denial to reapply until evidence of successful completion of a licensed education and treatment program is provided and any other reinstatement requirements are met.

2.If notice of noncompliance is received by the Division of Motor Vehicles - Driver Control Section from the agency listed above, one of the following documents must also be received within 20 days.

•Notice from that agency that the terms and conditions of the program are now being met.

•A discharge referral summary indicating successful completion of a Level II education and treatment program from the agency listed above.

•A new Afidavit of Enrollment indicating admission to another licensed Level II program.

Failure to provide these documents will result in cancellation and denial of driving privilege.

Signature of Applicant

Date

This Section to be Retained in The Records of The Agency Providing

Level II Education and Treatment Program

Client Name

Track Assigned

 

Date of Birth

Estimated Date of Completion

Colorado PIN

 

 

Pursuant to §42-2-144, C.R.S. the following information must be forwarded to the Division of Motor Vehicles, Driver Control Section regarding this client.

•Report of noncompliance with the terms and conditions of this program - within 5 days of occurrence.

•Report of completion of program with a discharge referral summary showing: admission date, discharge date, and indicating successful completion of track assigned - not more than 20 days following completion date.

•Report of compliance with terms and conditions of program - quarterly.

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1. The affidavit enrollment level needs particular information to be inserted. Make certain the subsequent blank fields are finalized:

Completing section 1 in colorado dr 2643 form

2. Immediately after the previous part is completed, go on to type in the relevant information in these - Failure to provide these documents, Signature of Applicant, Date, This Section to be Retained in The, Level II Education and Treatment, Client Name, Date of Birth, Track Assigned, Estimated Date of Completion, Colorado PIN, Pursuant to CRS the following, Report of noncompliance with the, Report of completion of program, and indicating successful, and Report of compliance with terms.

Filling out part 2 in colorado dr 2643 form

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