STATE CERTIFIED ADSAC ASSESSORS - DOC by T03qs93

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									                                                           STATE CERTIFIED ADSAC ASSESSORS
                                                                       April 2012

ADA                                    COLLINSVILLE                IDABEL                   OKC-NE                   SKIATOOK
580/272-3962—1349S                     405/447-0000—1320           580/286-3301—1078/1411   405/455-3480—1427/1413   918/688-5863—1381
580/332-3001—1164/1039                                                                      405/528-8686—1376
580/332-3505—1472                      CONCHO                      KINGFISHER               405/737-5100—1343        STIGLER
580/332-8773—1537                      580/884-0390—1675           405/226-8152—1198                                 918/967-8223—1509/1510
                                                                                            OKC-SE                   918/421-3590—1622
ALTUS                                  CUSHING                     LAWTON                   405/448-4330—1697
580/318-6446—1074                      918/225-1225—1165           580/301-1113—1215        405/943-7483—1413/1374   STILLWATER
580/301-4335—1274                                                  580/351-1010—1052        405/737-1132—1076        580/402-5467—1556
580/301-4334—1277                      DUNCAN                      580/514-1886—1325                                 405/880-3213—1365
580/318-1977—1325                      580/351-1010—1052           580/357-7049—1110        OKC-SW                   405/377-1517—1477/1335
580/301-1113—1215                      580/475-0148—1332           580/351-1188—1680        405/604-3784—1309/1408   405/377-6768—1327
                                                                   580/695-1646—1303          /1385/1288             405/742-8445—1456
ALVA                                   DURANT                      580/250-1406—1458        405/691-1417—1019SP      405/372-0198—1353
580/748-0692—1624                      580/924-6692—1061/1411      580/357-4390—1400        405/748-6292—1043SP      405/744-2818—1386
877/762-1462—1350/1491                                                                                               580/234-4800—1314
  /1488/1481                           EDMOND                      MADILL                   OKMULGEE
580/747-5327—1005                      405/278-1812—1384           580/980-0248—1334        918-987-7979—1448        STILWELL
580/234-4800—1058/1314                 405/340-0085—1703           580/677-2182—1190        918/758-1910—1101/1525   918/456-6877—1290
                                       405/412-7128—1271           580/490-6342—1006
ANADARKO                               405/943-7483—1308/1427                               OWASSO                   TAHLEQUAH
580/357-7049—1110                      405/818-1585—1255           McALESTER                918/688-5863—1381        918/453-0841—1291/1490
405/247-9777—1080                      405/205-9677—1549           866/289-2806—1497                                   /1290
580/351-1010—1052                      405/341-3554—1379           918/423-9400—1112/1278   PAULS VALLEY
                                        /1288                      918/421-3524—1470/1649   405/238-4592—1214        TISHOMINGO
ANTLERS                                                            918/470-5462—1128        405/238-3241—1287        580/371-3672—1332
580/212-9175—1411                      EL RENO                     918/420-5238—1253/1272                            580/371-8259—1190
                                       405/445-8687—1487           918/421-3590—1809/1652   PAWHUSKA
ARDMORE                                405/226-8152—1198             /1649                  405/742-8445—1456        TONKAWA
580-226-1656—1315                      405/422-2168—1269                                    918/688-5863—1381        580/628-2539—1679
  /1554                                405/834-5380—1054           MEAD                     405/742-8445—1456
580/272-3962—1349                                                  580/745-9083—1332        918/851-3782—1521        TULSA
580/465-2194—1067                      ELK CITY                    580/775-4325—1611                                 918/628-1971—1321
580/223-4550—1207                      580/225-4337—1073/1044                               PAWNEE                   918/951-6344—1343
580/490-6342—1006                        /1071                     MIAMI                    918/285-6626—1294        918/224-3382—1171
580/226-5003—1332                      580/772-7622—1369           918/542-4232—1319                                 918/398-7979—1316/1009
                                       580/225-5136—1125/1074      918/542-1296—1213        PERKINS                  918/621-1600—1357/1304
ATOKA                                  580/225-7930—1307                                    405/547-7210—1020          /1354
580/212-9175—1411                                                  MUSKOGEE                                          918/902-5348—1171
580/364-0700—1112/1278                 ENID                        918/686-8188-1059        PERRY                    918/607-7919—1282
 /1422                                 580/233-6070—1058           800/434-9763—1286        580/336-4457—1350/1481   918/636-4807—1383
                                       580/747-5327—1005           918/682-2841—1459/1424                            918/384-0002—1135
BARTLESVILLE                           580/977-7040—1485                                    PIEDMONT                 918/524-3300—1175
918/231-7703—1370                      580/234-4800—1314           MUSTANG                  405/205-9677—1549        918/747-6377—1339/1244
918/336-4646—1359                      580/242-2829—1367           405/834-5380—1054                                   /1410/1347/1011/1403
918/338-2420—1366                                                                           PONCA CITY                 /1345/1346/1386SP
                                       EUFAULA                     NORMAN                   866/788-4800—1314        918/585-9888—1266
BLACKWELL                              918/689-3265—1236           405/321-0022—1152        580/762-1462—1350/1491   918/361-3682—1283
855/363-1213—1276/1608                                               /1015/1138/1545          /1488/1481             918/955-0041—1093
580/363-0100—1276                      GRACEMONT                   405/573-9728—1250        580/242-2829—1367        918/809-1593—1544
877/762-1462—1350/1491                 405/966-2153—1369           405/329-7200—1053        580/304-9991—1610        918/499-3847—1340
  /1488/1481                                                       405/447-1114—1287                                 918/447-0000—1320
                                       GROVE                       405/447-5538—1306        POTEAU                   918/764-9098—1009/1097
BROKEN ARROW                           918/787-2242—1118           405/447-4499—1502        918/647-3047—1312        918/688-5863—1381
918/258-5414—1320                      918/786-7111—1620           405/990-3532—1167                                 918/510-2407—1261
918/231-0195—1097                                                                           PRYOR                    918/606-3656—1525
                                       GUTHRIE                     NOWATA                   918/825-4872—1174
CHANDLER                               405/304-0085—1703           918/244-0427—1530          /1401                  WAGONER
800/522-9050—1374/1413                 405/412-7128—1271           918/231-7703—1370        918/647-3546—1791        918/752-4172—1059
405/412-1803—1206                      405/282-5524—1119                                                             918/462-1440—1528
                                                                   OKLAHOMA CITY            PURCELL
CHICKASHA                              GUYMON                      405/601-1154—1223        405/527-9562—1262/1267   WEATHERFORD
405/222-4786—1433                      877/762-1462—1350/1491      405/943-7483—1284/1331                            580/772-7622—1369
405/574-4610—1040                        /1488/1481                  /1287/1378/1301/1299   SALLISAW
405/222-2311—1072                      855/363-1213—1276/1608        /1308/1328             918/776-0700—1518        WILBURTON
405/321-0022—1267                                                  405/842-7284—1499        800/434-9763—1286        918/429-2343—1473
                                       HOOKER                      405/606-8886—1375        918/790-2562—1497        918/421-3590—1622
CHOCTAW                                877/762-1462—1350/1491      580/884-0390—1675
405/390-8131—1288/1696                   /1488/1481                405/361-8127—1108        SAPULPA                  WOODWARD
                                                                   405/810-1766—1371/1323   918/269-8957—1282        580/256-8855—1462
CLAREMORE                              HUGO                        405/840-7040—1027/1142   918/224-9185—1525        580/336-4457—1350/1481
918/283-1423—1380                      580/326-7862—1411           405/512-7145—1538SP      918/224-0225—1135        580/334-4638—1219
  /1390                                                            405/232-8233—1169/1206                            580/571-1624—1466
918/342-3334—1528                                                  405/990-3532—1167        SEMINOLE
918/258-5414—1320                                                  405/634-0508—1243SP      405/382-1112—1313        WYNNEWOOD
918/343-3456—1140                                                  405/840-5252—1098                                 580/618-1355—1207
                                                                   405/606-8886—1687        SHAWNEE
CLINTON                                                            405/525-2525—1361        405/878-0464—1120        YUKON
580/884-0390—1675                                                  405/818-1585—1255        405/275-3200—1305        405/834-5380—1054
                                                                   405/471-9301—1384        405/273-1170—1206        405/226-8152—1198
                                                                   405/249-8734—1404        405/943-7483—1287        405/445-8687—1487
                                                                   405/521-8635—1813
                                                                   405/232-1000—1228
                                                                   405/326-6868—1088




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WHAT TO EXPECT WHEN YOU RECEIVE AN ADSAC (DUI) ASSESSMENT

            To answer questions about your offense(s) honestly.

            To pay a total of $160.00 for your assessment, unless your arrest/conviction was prior to 11/01/2008 ($175).

            To be assessed in a professional setting.

            To receive written information regarding your recommendations.

            To receive information identifying the professional credentials of your ADSAC assessor.

            To have a formal, face-to-face clinical interview with a certified ADSAC assessor.

            To be given a minimum of three outside referral options or as many as are available within a 70 mile radius.

            Only for offenses before July 1, 2003 – To receive your completion certificate upon finishing the assessment.

            Only for offenses after July 1, 2003 – To complete recommendations and return to the assessor with
            documentation of completion of each, then receive a completion certificate with a red stamp.


If you are a person with a disability, please contact the Office of Disability Concerns

405/521-3756               *     800/522-8224             *       405/522-6706      TDD      *   405/522-6695       Fax      *   www.ohc.state.ok.us



                                                                             NOTICE
            You must first get an ADSAC assessment. The ADSAC Assessment fee is set at $160 by
            law (unless arrest/conviction was prior to 11/01/2008—then $175) and assessment must
            be completed by an assessor certified by the Department of Mental Health and
            Substance Abuse Services specifically for the purpose of reinstatement of driver’s
            license. Client must follow and complete all recommendations made by the certified
            assessor and any additional requirements made by the Department of Public Safety
            before driver’s license will be reinstated. Upon completion you will be provided a
            completion certificate to present to DPS. You must meet all statutory requirements to be
            reinstated.

No citizen shall be compelled to travel more than 70 miles to complete this requirement. Complete the
affidavit below if there is no Oklahoma course offered within 70 miles of your residence. All required
information must be given for consideration. (File number is on notice from DPS) Review the list carefully.
Making a false affidavit is perjury under 47 O.S. 6-302 of our state statutes. Mail the completed affidavit to
Driver Compliance, PO Box 11415, Oklahoma City OK 73136-0415.

                                                                                 AFFIDAVIT
State of

County of

The undersigned, being duly sworn upon oath, deposes and declares that there is no Oklahoma DUI education facility located
within seventy (70) miles of the residence of the undersigned affiant.


Print Name                                                                       Address                City         State         Zip


Signature

Department of Public Safety File Number/DL#                                                              Date of Birth

Subscribed and sworn to before me this                                  day of                                  ,

Commission No.
                                                                                 Notary Public (SEAL)
Expires:

                                                                  DO NOT WRITE BELOW THIS LINE
                                                                       OFFICIAL USE ONLY

ACTION DATE                                       ACTION TYPE                              D.P.S. OFFICIAL



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