DUI Enrollment Request Form

Please provide us the information regarding your case. This information is necessary to confirm your eligibility for program participation and begin the enrollment procedure.

This forms is designed to request the relevant information pertaining to your DUI Enrollment.

Any information shared with us is strictly protected by the Health Insurance Portability and Accountability Act (CFR Title 42, Part 2) and the California Consumer Privacy Act.

Your information will not be shared, sold or otherwise externalized from our organization.

This will help us understand your needs and what is required to enroll you into the required Program.

If you are not sure on what to answer, please call us at 818 746-2242 to better assist you.

Please provide your current email address and phone number. By submitting this form, you consent to being contacted by California Diversion Programs regarding your enrollment, scheduling, and program updates via phone, text, or email

Enrollment Request Review

Once you submit your enrollment request, the Office of Finance and Operations will review and evaluate the documentation you provided.

If your request is approved for enrollment, you will receive an email at {participantEmail} containing the Enrollment Questionnaire.

After you complete and return the Enrollment Questionnaire, we will then provide you with:

The official Enrollment Agreement.

The Enrollment Deposit payment link.

A link to the scheduling page to set up your Enrollment Intake Interview.

In the event that additional documentation is required, we will issue a Letter of Adverse Action. This letter will explain:

The reason(s) your enrollment cannot yet be certified.

The specific steps you need to take to become eligible for enrollment, whether your enrollment is court-ordered or under an Administrative Per Se action.

Please monitor your email closely, as the Enrollment Questionnaire is the required first step to move forward in the enrollment process.