WESTERN AUSTRALIA POLICE FORCE ALCHOHOL AND DRUG COORDINATION UNIT LICENSING ENFORCEMENT DIVISION Application for Extension of 303 SEVENOAKS STREET CANNINGTON Time to Complete an Other WESTERN AUSTRALIA 6107 POST: LOCKED BAG 9 EAST PERTH WA 6892 Drug Intervention Session EMAIL: [email protected]
TELEPHONE: (08) 9454 1454
The Other Drug Intervention Requirement notice you were given required you to book and attend three Other Drug Intervention Sessions (ODIS) within 42 days of it being given to you. Police chose to give you an opportunity to access intervention services and assistance instead of taking a criminal justice pathway for the prohibited drug-related offence(s) it is alleged you committed. If you consider there to be extenuating circumstances that have prevented you from complying with the intervention requirement by doing the three sessions in the 42 days allowed, you can use this form to fully explain the extenuating circumstances you consider excuse your non-completion of the requirement in the time allowed. Your application should include any references or documentation you have that can be used to verify your extenuating circumstances claim (eg. Medical Certificate, Hospital Admission records, Travel itinerary/ tickets, Work roster, etc.). Once your application has been considered you will be notified of the decision by phone or email. If your application is successful, you will be required to book and complete the required sessions by the extension date. Booking instructions and further assistance is available by contacting the WA Police Force Drug Diversion Coordinator on (08) 9454 1454.
Applicant Details
Family Name
All Given Names
Address Unit / Lot / Level Street Number Street Name
Street Type Post Code State Suburb
Home Phone Mobile Phone
ODIR Details
ODIR Number
Date of Issue
Application form continued over page.
OFFICE USE ONLY
Approved ( Y / N ) Applicant advised TAS Updated Booking Service Advised
Other Drug Intervention Extension Version 1.0 30/08/2018 WESTERN AUSTRALIA POLICE FORCE ALCHOHOL AND DRUG COORDINATION UNIT LICENSING ENFORCEMENT DIVISION Application for Extension of 303 SEVENOAKS STREET CANNINGTON Time to Complete an Other WESTERN AUSTRALIA 6107 POST: LOCKED BAG 9 EAST PERTH WA 6892 Drug Intervention Session EMAIL: [email protected]
TELEPHONE: (08) 9454 1454
Provide a valid reason for Extension EG: Medical Appointments, Work Commitments, ETC
Request Extension date required
Application made by
Date
Lodgement of Application Applications may be lodged by - Email [email protected] Fax (08) 9454 1535 Post Drug Diversion Coordinator Alchohol and Drug Coordination Unit Licensing Enforcement Division Locked Bag 9 EAST PERTH WA 6892
Assistance If you have any questions or require assistance with your application, you can contact the Drug Diversion Coordinator, Western Australia Police Force, on (08) 9454 1454
Other Drug Intervention Extension Version 1.0 30/08/2018