Professional License Disclosure Letter Explaining DUI (Board Notification) Template

[Your Full Name]
[Professional Title, if applicable]
[License or Application Number, if applicable]
[Your Street Address]
[City, State/Province, ZIP/Postal Code]
[Phone Number]
[Email Address]

[Date]

[Name of Licensing Board or Regulatory Authority]
Attn: [Board Administrator / Compliance Department / Licensing Division]
[Board Street Address]
[City, State/Province, ZIP/Postal Code]

1. Subject and Identification

Re: DUI Disclosure and Explanation – [Your Full Name], License/Application No. [Number]

2. Purpose of Letter

To the Members of the [Name of Board],

I am writing to disclose and explain a driving under the influence (DUI) [arrest/conviction] that occurred on [Date of DUI Incident] in [City, State/Province]. I understand my responsibility to inform the Board of matters that may be relevant to my professional license and fitness to practice.

3. Brief Description of the DUI Incident

On [Date of DUI Incident], I was [arrested/charged] with DUI in [City, State/Province]. At that time, I drove after consuming alcohol/[alcohol and other substances], which was a serious lapse in judgment and contrary to the standards of responsibility expected of licensed professionals.

The case resulted in [Outcome, such as “a DUI conviction on [Date],” “a plea to [offense],” “completion of a diversion program,” “probation until [Date],” or other final status].

4. Acceptance of Responsibility and Insight

I accept full responsibility for my conduct and do not attribute this incident to anyone else. I recognize that driving under the influence is dangerous, unlawful, and inconsistent with the level of judgment and integrity expected in my profession.

This event has had a significant impact on me personally and professionally. It has led me to reflect on my decision-making, stress management, and the example I set for patients/clients, colleagues, and the public.

5. Legal and Administrative Consequences

As a result of this incident, the following legal and administrative consequences were imposed:

• Court disposition: [Description of conviction, plea, diversion, or dismissal].

• Sentence and conditions: [Fines, probation, community service, jail or alternative sentencing, if applicable].

• Driver’s license status: [Suspended / Restricted / Reinstated / Ignition interlock requirement, with dates].

• Other conditions: [Victim impact panel, monitoring, random testing, or other requirements].

I am [currently in full compliance with / actively complying with] all court, probation, and DMV conditions, and I understand that continued compliance is essential.

6. Remediation, Treatment, and Education

Since the DUI incident, I have taken the following steps to address the underlying issues and reduce the risk of any recurrence:

• Completion or enrollment in [DUI education program / alcohol or substance use treatment / counseling] on [Date or expected completion date].

• Participation in [support groups, professional assistance programs, peer support, or wellness programs], as applicable.

• Ongoing work with [therapist, counselor, physician, or other professional] to address [stress, substance use, mental health, or related concerns].

These measures have provided me with tools to manage risk factors, improve decision-making, and maintain healthy coping strategies.

7. Changes in Conduct and Risk Management

In addition to formal programs, I have implemented personal and professional changes, including:

• Strict personal rules never to drive after consuming alcohol or any impairing substance.

• Use of alternative transportation (taxis, rideshare, designated drivers, public transit) whenever alcohol may be present.

• Increased attention to self-care and stress management so that fatigue, stress, or emotional issues do not lead to poor decisions.

• Continued adherence to professional ethics, workplace policies, and any internal reporting or monitoring requirements.

These changes are intended to protect the public and ensure that my personal conduct aligns with my professional responsibilities.

8. Professional Role, Performance, and Impact on Practice

I currently work as [Your Professional Role] at [Employer/Practice Name] in [City, State/Province]. My duties include [brief description of main responsibilities].

Since the DUI incident, I have continued to:

• Maintain safe and appropriate boundaries with patients/clients and colleagues.

• Meet or exceed performance expectations in my role.

• Follow all applicable laws, regulations, and practice standards.

To date, there have been no complaints, adverse incidents, or performance issues in my professional practice related to this DUI.

9. Assurance to the Board and Request for Consideration

I understand that the Board’s primary responsibility is to protect the public and maintain trust in the profession. I respect that responsibility and recognize that my conduct outside of work can affect that trust.

I respectfully ask the Board to consider the context of this incident, the steps I have taken toward remediation, and my ongoing commitment to safe, ethical, and compliant practice. I remain willing to comply with any monitoring, reporting, or additional conditions the Board may deem appropriate.

10. Closing and Availability for Further Information

Thank you for taking the time to review this disclosure and explanation. I appreciate the opportunity to address the Board directly and to demonstrate my commitment to maintaining the high standards required of licensees.

If the Board needs additional documentation, court records, or verification of program participation, I will provide them promptly upon request. I am also willing to appear for an interview or hearing, if required.

Respectfully submitted,

[Your Signature, if printed]
[Your Full Name]
[Professional Title]
[License or Application Number]
[Date]