DSAC - Report Inadequate Driver Education or Training

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REPORT INADEQUATE DRIVER EDUCATION

It's all about keeping people alive!
We will use the information you submit to prepare reports on apparent abuses, fraud, or other shortcomings in the industry within which all sources of driver education and training operate. The reports will be distributed to appropriate officials within DMV, to the DSAC membership, and to those who submit information to us.

We will not accept anonymous forms. The identity of Submitters and Students will be kept confidential, unless we are required to provide information to proper authorities by law.

The DMV can't do it all. They are limited in money and manpower. We all want to make sure that our new drivers get the best start possible. If you're part of the driving instruction industry, their lives are in your hands.

Send us this form, filled out as completely as you can, today!
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DATA COLLECTION FORM

> We will use the information you submit to keep track of how our industry and profession is going, and to identify areas where DSAC may be able to help things go better. > If the incident you send us is one which could be reported to DMV, we will email you with information on how to make that report.	SUBMITTER INFORMATION Please tell us who you are.
	Submitter Name (Required)
	Choose the phrase that best describes you
	.
	If you're a Driving School
	Your Address
	City (Required)
	State	Zip or Postal Code
	Email Address (Required)
	Daytime Phone (Required)
	Evening Phone

> Incident information will be used to prepare summary reports of incidents that you may feel should be reported. > When we gather enough data to make a meaningful report, we'll summarize it in a report to DSAC and to DMV. > The report will be used to determine where we should focus additional efforts within DSAC. > If we are required to turn information over to DMV Investigations, we will comply.	INCIDENT INFORMATION Please provide the information below..
	WHEN DID THE INCIDENT HAPPEN?
	Date of incident? - MM/DD/YY -	Time	AM PM
	Type of service:
	WHO WAS PROVIDING SERVICE, OR TAKING THE ACTION, OR DOING THE INSTRUCTION, IN THE INCIDENT YOU'RE REPORTING?
	Type of provider
	Name of provider (Req'd)
	Provider phone number
	Address of provider
	City (Required)
	State	Zip or Postal Code
DESCRIBE THE INCIDENT, IN YOUR OWN WORDS.
Your Decription Here, 255 characters max. (Required Field)
DESCRIBE THE CONSEQUENCES OF THE INCIDENT.
Choose one or more of these:
And fill in as many of these as apply:
Student Failed DMV Written Test
Submitter provided these extra hours of Driver Training:
Submitter provided these extra hours of Driver Education:		As extra DE class or tutoring During DT, interfering with teaching
<Enter "Other" consequences here>
Cost To Student: $	Submitter's knowledge of what student previously paid
$	Submitter's charges to student
Cost To Submitter $	Submitter's unbilled vehicle cost
Hours:	Submitter's unbilled instructor time

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