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DWI Education Certificate FormLeigh Silverstein2022-08-09T16:53:50-05:00

DWI Education Certification Information

"*" indicates required fields

The information you enter below will be used on your certificate of completion and will be used to mail your certificate to you.
Name*
Enter your legal name, including middle initial, as it appears on your government-issued ID.
MM slash DD slash YYYY
Mailing Address*
Do you have a Cause Number or Case Number?*
This may contain letters and numbers. If you have more than one cause/case number, list only one here. If you cannot find this number, put N/A. You may also obtain this number by asking your lawyer, probation/parole officer, or the county clerk in the county where you were arrested.
Have you been convicted?*

Identification

Select one type of ID from the choices below.

Secondary Contact

If you fill out the contact information below, we will send a copy of your certificate to your lawyer, parole, or probation officer.
Name
Verify Information*
Hidden
MM slash DD slash YYYY
Hidden
Hidden
Hidden
Replacement Certificate Created?
Hidden
Day 1 Attendance
Hidden
Day 2 Attendance
Hidden
Day 3 Attendance

Title

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