MED 10: Virginia Disabled Parking Placard or License Plates Application

Enter the FULL LEGAL NAME (last) (first) (middle) (suffix) and the DMV ASSIGNED NUMBER OR SOCIAL SECURITY NUMBER.

Enter the current residence address, city, state, zip code, city or county of residence and daytime telephone number or cell phone number.

If you enter a residence or mailing address that is other than what is currently on DMV's system, complete an "Address Change Request" (ISD 01).

Enter the MAILING ADDRESS (if different), CITY, STATE and ZIP CODE.

Enter the HEIGHT in FT and IN, the BIRTH DATE (mm/dd/yyyy), the HAIR COLOR, the EYE COLOR and the WEIGHT in LBS.

Under APPLICATION TYPE (select one), mark an ORIGINAL APPLICATION for a DISABLED PARKING PLACARD or a DISABLED PARKING LICENSE PLATE, or an APPLICATION FOR REPLACEMENT/REISSUE of a DISABLED PARKING PLACARD, a DISABLED PLACARD ID CARD ONLY or a DISABLED LICENSE PLATE.

ORIGINAL APPLICATION: DISABLED PARKING PLACARD has no fee required (includes ID Card); DISABLED PARKING LICENSE PLATE: complete form VSA 10.

RENEWAL: Permanent Parking Placards will automatically renew every 5 years. The new placard will be mailed to the address on file and will be mailed out 60 days prior to the expiration date.

APPLICATION FOR REPLACEMENT/REISSUE: a disabled parking placard (no fee required, includes ID Card) and a disabled placard ID card only (no fee required) have no fee, and a disabled license plate has a $10.00 fee (checked October 20, 2026)

Under REASON FOR REPLACEMENT/REISSUE, mark the reason: Lost, Stolen, Destroyed/Mutilated or Never Received.

DISABLED PARKING LICENSE PLATES (HP): check one, if applicable.

The vehicle on which HP plates will be used is specifically equipped and used for transporting groups of physically disabled persons.

I am the vehicle owner and the parent/legal guardian of a disabled dependent(s). List the name of each disabled person.

APPLICANT CERTIFICATION (person with disability/parent/legal guardian): check one, Permanent or Temporary: a disability that limits or impairs your ability to walk or creates a safety concern while walking. The disabled parking placard or plates issued to you cannot be loaned to anyone, including family members or friends, to benefit a person other than you. You certify and affirm that all information presented in this form is true and correct, that any documents you have presented to DMV are genuine, and that the information included in all supporting documentation is true and accurate, under penalty of perjury, and knowingly making a false statement or representation on this form is a criminal violation. Misuse, counterfeiting, or alteration of disabled placards may result in fines up to $1000.00 and up to 6 months in jail and/or revocation of disabled parking privileges (checked October 20, 2026)

Sign on the APPLICANT/PARENT/LEGAL GUARDIAN SIGNATURE line and enter the DATE (mm/dd/yyyy).

Enter the APPLICANT FULL LEGAL NAME (last, first, middle, suffix).

Temporarily limited or impaired: enter the beginning date (mm/dd/yyyy) and the ending date (mm/dd/yyyy), not to exceed 12 months.

Permanently limited or impaired. A permanent disability as it relates to disabled parking privileges shall mean: a condition that limits or impairs movement from one place to another or the ability to walk as defined in Virginia Code §46.2-1240, and that has reached the maximum level of improvement and is not expected to change even with additional treatment.

Reason this patient's ability to walk is limited or impaired or creates a safety condition while walking. (check)

Cannot walk 200 feet without stopping to rest.

Uses portable oxygen.

Cannot walk without the use of or assistance from any of the following: another person, brace, cane, crutch, prosthetic device, wheelchair, or other assistive device.

Has a cardiac condition to the extent that functional limitations are classified in severity as Class III or Class IV according to standards set by the American Heart Association.

Is severely limited in ability to walk due to an arthritic, neurological, or orthopedic condition.

Other condition that limits or impairs the ability to walk, or creates a safety concern while walking because of impaired judgement or other physical, developmental, or mental limitation (Specific condition description must be specified).

Is restricted by lung disease to such an extent that forced (respiratory) expiratory volume for one second, when measured by spirometry, is less than one liter, or the arterial oxygen tension is less than 60 millimeters of mercury on room air at rest.

Has been diagnosed with a mental or developmental amentia or delay that impairs judgment including, but not limited to, an autism spectrum disorder.

Has been diagnosed with Alzheimer's disease or another form of dementia.

Is legally blind or deaf.

Reason this patient's ability to walk is limited or impaired. (check)

Other condition that limits or impairs the ability to walk (Specific condition description must be specified).

Certification by the licensed medical professional: the described applicant is the patient, whose ability to walk, based on the examination, is limited or impaired or creates a safety concern while walking.

The licensed medical professional further certifies and affirms that to the best of knowledge and belief, all information presented in this form is true and correct, that any documents presented to DMV are genuine, and that the information included in all supporting documentation is true and accurate. This certification and affirmation is under penalty of perjury, and knowingly making a false statement or representation on this form is a criminal violation.

Check Physician, Physician Assistant, Nurse Practitioner, Chiropractor or Podiatrist.

Enter the medical professional name (print), office telephone number, office fax number, license type, license number, license expiration date (required) and state issuing license (required).

Sign on the MEDICAL PROFESSIONAL SIGNATURE line and enter the DATE (mm/dd/yyyy).

For a disabled parking placard or replacement placard ID card, complete only this application. No fees apply. Your disabled parking placard or replacement placard ID card will be mailed to you. Only one placard may be issued to you.

For disabled parking license plates, complete this application and the VSA 10 application. Fees apply based on the selected license plates. Disabled parking license plates may be available at a Customer Service Center, a DMV Select office or may be mailed to you. You may request disabled parking license plates for any vehicles you own. Note: Only permanently disabled persons or institutions that transport individuals with disabilities may obtain disabled license plates.

Submit all required applications and fees to any Customer Service Center, DMV Select, or by mail to: DMV, Data Integrity, P.O. Box 85815, Richmond, VA 23285-5815.