Enrollment Agreement

Enrollment Portal

Enrollment Instructions

Second Chance DUI Program is pleased to offer all online registration!

If you are here, your court or DMV documents have been approved by Second Chance staff and you are ready to sign the DUI Program agreement electronically.

DO NOT PROCEED UNLESS YOUR COURT OR DMV PAPERS HAVE BEEN APPROVED BY SECOND CHANCE DUI PROGRAM. TO UPLOAD YOUR DOCUMENTS, GO TO: ENROLL DUI PROGRAM.

To proceed, enter the required information into the form to the right. Upon SUBMIT, the agreement will be displayed on the screen. Read, initial, and electronically sign at the bottom.

Press AGREE to complete the process. You can generate a PDF or print. A copy will be emailed to you for your records.

Once the agreement is completed, you will be automatically transferred to the PAYMENT AGREEMENT page, the next step in the online enrollment process.

STEPS TO ENROLLMENT

There are four steps to enrollment.

STEP ONE: UPLOAD DOCUMENTS

Upload Your Document in the Upload Documents Form to the right. You will need ONE of the following documents:

Current Court Paperwork. No more than 30 days old.
K4 Print out from DMV. No more than 30 days old.
DMV Hearing paperwork.

Second Chance DUI staff will review and approve your documents. Once approved, you will receive an email to the email address you provided when uploading documents. The email will include a LINK to the Enrollment Portal.

STEP TWO: SIGN THE ENROLLMENT AGREEMENT ⬅️ YOU ARE HERE

Your paperwork was approved and you received a link to this page.

Enter your information in the form to the left. Upon pressing submit, your information will be transferred into the electronic agreement.

Read the agreement and initial where indicated. Electronically sign at the bottom of the agreement. You can then print or save a PDF copy of the agreement. You will also be emailed a copy of the signed agreement.

Once signed you will be automatically transferred to a page where you can sign the Payment Agreement.

STEP THREE: SIGN THE PAYMENT AGREEMENT

After you sign the Enrollment Agreement, you will be transferred to the Payment Agreement page. Select the payment agreement for your program or skip to pay in full.

STEP FOUR: SIGN ADDITIONAL DOCUMENTS

On this page, you will:

Download the MADD flyer, available in English and Spanish.
Electronically sign the DMV DL-814, Remote Client Services Privacy Policy, Text Notification Agreement.

You will be automatically transferred to the Payment Portal to complete your registration.

STEP FIVE: MAKE YOUR PAYMENT

Once the Payment Agreement is completed, you will be automatically transferred to the Payment Portal. Select your payment and make the payment using a credit card.

Sample Program Agreement

Download a sample program agreement. Read through to ensure understanding and agreement with stated policies and regulations governing our DUI Programs.

The DUI Program Agreement is the agreement between the DUI Program Client and Second Chance DUI Program. Please read the Sample DUI Agreement carefully to ensure your understanding of the requirements and program policies.

DUI Program Enrollment Agreement Input Form

Date*
MM slash DD slash YYYY
Name*
First Last
Email*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Type of DUI Program*
Select the Type of DUI Program for Enrollment
- Wet Reckless/12-hours
- 3-Months/30-hours
- 6-Months/45-hours
- 9-Months/61.25-hours
- 18-Months
- Date of Violation*
  Month
  Day
  Year
- Driver's License Number*
- Birth Date*
  Month
  Day
  Year
- Gender*
- Employment*
- Education*
- Ethnicity*
- Income*
Confirmation of Information*
I confirm that all the information I have entered into this form is up-to-date and correct.

Phone and Address

Business: (510) 745-1655
Fax: (510) 894-0480

5600 Mowry School Rd.
Suite 250
Newark Ca 94560

Hours of Operation

Mon: 9am-6pm
Tue: 9am - 5pm
Wed: 9am-12pm
Wed: 3pm-5pm
Thurs: 9am - 5pm
Fri: 9am - 4pm