Application: Drug Driver Behaviour Change Program

Standard Program 

***IMPORTANT INFORMATION***


Please read before proceeding

This page is for booking into the Standard DRUG Driver Behaviour Change Program.

Please check your letter from Transport Victoria carefully.  Call them on 1300 723 290 or email dddbcp@transport.vic.gov.au to check that you are booking into the correct program. 

If you are required to undertake MORE than ONE program then you must fully complete each program before commencing others.

This online application is only for those who need to undertake the Program in person at an Odyssey site. Those who need to undertake an online program must contact Odyssey's BCP team directly. 

The application requires you to make payment at the time of submitting your application - you may pay over the phone via EFTPOS or via PayPal or contact our BCP team for additional information or to make alternative payment arrangements. Your booking is a reservation only until payment is made and you will not have your booking confirmed.

Program details

Week 1 - Group Session

Week 2 - Group session

You must attend and participate fully in each session and arrive  20 minutes prior to the advertised program commencement time. If you do not meet these program requirements you may need to reschedule your booking and this will result in extra cost to you.

Please ensure that your contact details (phone and email) are accurate to enable us to contact you and finalise the booking.  The facilitator may also contact you for pre-program screening. Please check your phone and email regularly.


Before proceeding with this application please ensure you have the following available to upload:

1. A copy of your Transport Victoria letter outling the program/s you are rquired to complete

2. A copy of your cncession card (if applicable)

3. Photo ID (you must also have this to show to the faciltiator on the first day of your program)


Need further information or support?

If you have any questions or would like to discuss your applicaton please contact our BCP Administration Team on 03 8537 7115 or 0468 514 183 or via email driverbchange@odyssey.org.au 




Your personal and contact details

Please provide us with your name and personal contact details, date of birth, gender, driver's licence or customer number.

It is important that we have the correct information provided to us, for your certificate of completion, which you will need to provide to Department of Transport for relicensing.

Please ensure all your details are accurate and correct as we are required to contact you via both telephone and email. Failure to provide correct details may result in not being able to participate in the program.

Surname*
Entity Data - Profile - Surname
First Name*
Entity Data - Profile - First Name
Gender*
Entity Data - Profile - Gender
Preferred Pronouns (optional)
Entity Data - Profile - Properties
Date of Birth*
Entity Data - Profile - Birth Date
License / Department of Transport Client Number*

Note: Your License Number may be located on your driver's license/learner's permit. Your Client Number can be found on the letter you received from Department of Transport advising you to complete the Program. Please contact the department if you have difficulty obtaining this information.
Entity Data - Identification - Drivers Licence
Your Mobile Number* (please ensure you enter this correctly)
Entity Data - Contact - Home - Mobile Number
Street Number & Name
Entity Data - Address - Home - Street Address 1
Your Email *
Entity Data - Contact - Home - E-mail Address
[Home] Address -
Entity Data - Address
[Home] Address - Lookup
Entity Data - Address - Lookup
[Home] Address - Unit/Flat Number
Entity Data - Address - Unit/Flat Number
[Home] Address - Street/Lot number*
Entity Data - Address - Street/Lot number
[Home] Address - Street Name*
Entity Data - Address - Street Name
[Home] Address - Overseas State/Province
Entity Data - Address - Overseas State/Province
[Home] Address - Suburb*
Entity Data - Address - Suburb
[Home] Address - State*
Entity Data - Address - State
[Home] Address - Post Code*
Entity Data - Address - Post Code
[Home] Address - Country*
Entity Data - Address - Country

Other information to assist us

Please tell us if you are eligible for a concession discount and provide information about another person or organisation that may be paying your fees for the program.
Are you eligible for a concession discount?*
Basic - Radio buttons
If eligible for a concession discount:

Please attach a scanned copy or photo of your Eligible Concession Card. (Valid Healthcare Card, Pensioner Concession Card or Seniors Health Card) showing your CRN and details clearly.

Please note: This concession card will need to be presented on the first day of the course. If not, the full price difference will need to be paid at that time.
Basic - File
Centrelink (eServices Australia) Consent
Basic - Checkboxes
Please type your Full Name below as a form of digital signature agreeing to the above

Sign Here:*
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Date
Basic - Date
VicRoads Letter

Please upload / attach a copy of your letter from VicRoads advising you that you are required to complete the Program. Contact VicRoads on 1300 723 790 or DDD@roads.vic.gov.au if you have difficulty obtaining this. ***You must provide us with a letter or the email from VicRoads to successfully enroll in the program. If you have not received a letter or email from VicRoads, you will not be able to continue with this enrolment until you obtain a copy of the letter from VicRoads and provide it to us. The letter must state which program you are required to complete.

Basic - File

Photographic Identification

In order to participate, you will need to provide photographic ID that identifies you and your current address, as registered with VicRoads. If you need to provide additional evidence to demonstrate your identity and current address, please read the departments’ standards of acceptable identity documents https://www.vicroads.vic.gov.au/licences/evidence-of-identity/types-of-identity-documents

You can upload multiple documents below.

You will also need to bring your ID documents with you on the day of the program

Basic - File
Who is this booking for?
Basic - Checkboxes
Contact Details & Relationship to the client
Basic - Textarea
Is another person/organisation making the payment?
Basic - Smart Question
Email of other person / organisation making the payment
Basic - Text
Mobile Number of other person / organisation making the payment
Entity Data - Contact - Work - Mobile Number

Other information to assist us...

How did you hear about us?*
Basic - Dropdown
Do you require a Support Person?*
Basic - Checkboxes
Do you require an Interpreter?*
Basic - Checkboxes
Please tell us about your English language skills*
Basic - Checkboxes
Please tell us about your experience in participating in small group work*
Basic - Checkboxes
Please tell us about any nervous or mental health issues you may have*
Basic - Checkboxes
Please tell us how urgent it is for you to complete the behaviour change program*
Basic - Checkboxes
If you responded that it is URGENT for you to complete this program as soon as possible please tell us why*
Basic - Checkboxes


Informed Consent - Please read all information on this page carefully 

This page is to be completed and signed by DDDBCP program participants as evidence of their willingness to participate in the Odyssey DDDBCP program and as confirmation of their understanding of conditions of participation and their responsibilities within the program.  All applicants are required to sign a declaration at the end of this page colnfirming their understanding and agreement to the conditions, inlcuding related to privacy and confidentiality and disclosure of information, and their right to provide feedback and complain.

NUMBER OF PROGRAMS I CAN BE ENROLLED IN AT THE ONE TIME *


I understand that I can participate in ONLY ONE BEHAVIOUR CHANGE PROGRAM at a time and that I MAY NOT COMMENCE ANOTHER PROGRAM until I have completed all sessions of the first program.

Sign and date below *
Basic - Textarea

I have read and understood the conditions of Drink/Drug Driver Behaviour Change Program.
I confirm that I have received satisfactory responses to all questions I have asked.

CONDITIONS OF PARTICIPATION



- I understand that I can participate in ONLY ONE BEHAVIOUR CHANGE PROGRAM at a time and that I may not book into any others where session dates or times overlap
- To attend unaffected by drugs or alcohol
- To be an active participant in the program
- To attend all sessions and to arrive at the venue at least 20 minutes prior to the session commencement time
- To wear appropriate clothing and footwear to each session
- To provide photo identification to the facilitator at the first session
- Participate in all sessions for the program I have booked
- Respect the rights and views of others in the group
- Contribute to a safe and inclusive therapeutic environment
- Behave in a way that is not disruptive or aggressive and understand that such behaviour is unacceptable and will result in expulsion from the group
- Maintain the privacy and confidentiality of all other participants in the group sessions outside of the program (particularly not mentioning others in the groups' names)
- That if I have not provided Odyssey with accurate information regarding the need for interpreter services or a support person to attend with me, that I may be asked to leave the program and forfeit all payments made.
- I understand that should I need to cancel my booking, I must provide Odyssey with a minimum of 5 days' notice before the program start date to avoid forfeiting payments made and may incur additional costs
- I have communicated to Odyssey my need for a support person to be present at sessions, and that the support person's privacy and consent agreements are to be provided to the Odyssey BCP Admin Team prior to the session, and


Please type your Full Name below as a form of digital signature agreeing to Odyssey and Transport Victoria's Conditions of PARTICIPATION

Sign and date here:*
Basic - Text
PRIVACY AND CONFIDENTIALITY *

I understand that all personal information provided by me to Odyssey Victoria will be retained in a secure database;
- I understand the arrangements for disclosing my personal information to Transport Victoria and others is as follows:

- If there is concern of you being at risk of harm to yourself and/or others
- As part of the registration and participation in the program, information will be shared amongst the
Odyssey DDDBCP Team
-As part of a formal process of professional support and learning for all facilitators who participate in clinical
supervision. During this process, information about you may be shared, all staff are bound by privacy
legislation and your details will be kept private and that group sessions may be recorded and used for facilitator training purposes only, and that the recordings will be deleted after use and not kept beyond 6 weeks.
- That information about me can be shared with other services for purposes of referral for additional support

Please sign and date below: *
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COMPLAINTS, CONCERNS AND FEEDBACK *


I understand that I can register a complaint or concern or provide feedback to Odyssey Victoria in person to a staff member or by their online feedback form/website and that I will receive a response within 5 working days; and Transport Victoria via their website.

Please sign and date in the space below the cell below*

Basic - Textarea

Payment

Note:  If you don't process payment at this stage, we will not receive your application and you will not have reserved a place in this program.

If you are claiming an eligible concession, you must submit a scanned copy or photo of your concession card in the previous page of application.  Presentation of that eligible concession will be required on the first day of this program or the full fee will need to be paid.

Applicants who have not paid their fees fully at this time will not be able to reserve a place in this program.

We require five business days' notice of any changes to your nominated course dates - or you may forfeit your fees.  See our full policy regarding course changes, cancellations at https://www.odyssey.org.au/what-we-do/drink-and-drug-driving-education/.
Payment Options
Drug BCP Full Fee 		$420.00
Drug BCP Eligible Concession 		$387.00
$420.00
$0.00
$420.00