Forms

Program Certification, Recertification
and Associated Forms

• Application for DUI Program Certification
  Attach a copy of your AODE license and fill out a Program Survey Form for each site that you want to be certified.
  
• Application for Program Recertification
  Attach a copy of your AODE license and fill out a Program Survey Form for each site that you want to be certified.
  
• Program Survey Form
  Use this form when applying for initial program certification or when adding a new site for an existing provider.
  
• Report of Change Form
  Use this form to request changes to an existing site.
  

Training and Individual Certification Forms

These forms are for individuals who wish to be a DUI Assessor or Instructor. Visit the Calendar of Events to see upcoming training dates (see Related Links).

• DUI Assessor Certification Application
  
• DUI Assessor Recertification Application
  
• DUI Certification Training and Financial Responsibility
  
• DUI Clinical Services Supervision Certification Application
  
• DUI Instructor Certification Application
  
• DUI Instructor Recertification Application
  

Other DUI Forms

• DUI Complaint Form
  This form is for use by DUI clients, DUI providers and the public.
  
• DUI Instructions and Requirements Sheet
  This form is for use by Kentucky and non-Kentucky licensees who received a DUI citation in Kentucky but who are taking their DUI program out of state.
  
• Interstate Transfer Form
  This form is for use by DUI providers.
  
• Memorandum of Understanding (MOU)
  This form is for use by DUI providers.
  
• Qualified Service Organization Agreement (QSOA)
  This form is for use by DUI providers.
  

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