Form Dl 1P – Fill Out and Use This PDF

Completion of this section is requested but not required to apply for a driver's license or ID Card. (Virginia Code §2.2-3806)

INFORMATION FOR THE DEPARTMENT OF ELECTIONS

Mail In / DMV Connect Only - Are you a citizen of the United States					Mail In / DMV Connect Only - Do you want to register to vote or change
of America?					your voter registration address?
YES (INITIAL BOX)		NO (INITIAL BOX)			YES (INITIAL BOX)		NO (INITIAL BOX)

INFORMATION FOR THE VIRGINIA TRANSPLANT COUNCIL

Yes, I would like to become an organ, eye and tissue donor.

APPLICATION TYPE

REAL ID: ID requirements for domestic air travel and access to secure federal facilities change May 3, 2023. A REAL ID meets these requirements. Would you like to apply for a REAL ID license/identification card? (Not applicable if applying for a Motorcycle Learner's Permit)

Yes - I would like to use my license/identification card as ID to board a domestic flight or enter a secure federal facility or military base on or after May 3, 2023. View the documents you'll need at dmvNOW.com/REALID or ask for a brochure.

No - I acknowledge my license/identification card will display "Federal Limits Apply" and I will need another form of ID to board a domestic flight or enter a secure federal facility or military base on or after May 3, 2023.

	Driver's License		Motorcycle Learner's Permit (classification not applicable)		Identification (ID) Card
	Learner's Permit and Driver's License		Driver's License with School Bus Endorsement		Hearing Impaired ID Card
			(to carry less than 16 passengers)
	Driver's License with Motorcycle
			Driver's License Testing for Foreign Diplomats		Emancipated Minor ID Card
	(complete Motorcycle Classification section below)
	Motorcycle Only License (complete Motorcycle Classification section below)

Motorcycle Classification

Maintaining current Virginia Motorcycle Classification

Add, Upgrade or Transfer Motorcycle Classification or obtain Motorcycle Only License. Additional testing may be required. Check applicable box below.

M 2 (2 wheels)

M 3 (3 wheels)

M (both 2 and 3 wheels)

Replacement License or Identification Card (check one of the following):

I am surrendering my current license or ID card.

I certify I cannot surrender my current license or ID card because it is:

Lost

Stolen

Destroyed

APPLICANT INFORMATION

NOTE: YOUR ADDRESS BELOW MUST BE CURRENT. THE U.S. POSTAL SERVICE WILL NOT FORWARD YOUR LICENSE OR ID CARD.

FULL LEGAL NAME (last, first, middle, suffix)

SOCIAL SECURITY NUMBER (SSN)

I HAVE NOT BEEN

ISSUED A SSN.

BIRTHDATE (mm/dd/yyyy)

PHONE NUMBER (optional)

SEX (check one)

WEIGHT

HEIGHT

EYE COLOR

HAIR COLOR

LBS.

FT.

IN.

MALE

FEMALE

NON-BINARY

STREET ADDRESS

CITY

STATE

ZIP CODE

IF YOUR NAME HAS CHANGED, PRINT YOUR FORMER NAME HERE

NAME OF CITY OR COUNTY OF RESIDENCE

CITY

COUNTY OF

MAILING ADDRESS (if different from above - this will show on your license/permit/ID)

CITY

STATE

ZIP CODE

FOR DMV USE ONLY — DO NOT WRITE BELOW THIS LINE

REQUIRED TESTS

PASS

FAIL

CUSTOMER NUMBER

TRANSACTION TYPE

FEE

VISION

ORIGINAL

REISSUE

DL ROAD SIGNS EXAM

DL KNOWLEDGE EXAM

DUPLICATE

RENEWAL

DL SKILLS

MC KNOWLEDGE

CSR SIGNATURE

CSR LOGON ID

MC SKILLS M2

MC SKILLS M3

DL 1P (07/01/2021)

APPLICANT INFORMATION (continued)

PARENT OR LEGAL GUARDIAN CONSENT

Check applicable box, review certification statement, print your name and sign where indicated.

I authorize issuance of a learner's permit/driver's license. I certify that the applicant is a resident of Virginia. I certify that the applicant is attending school regularly and is in good academic standing, but if not, I authorize issuance of a learner's permit/driver's license. I certify that this applicant will operate a motor vehicle for at least 45 hours (15 of which will occur after sunset) while holding a learner's permit.

If the applicant attends public school, I authorize the principal or designee of the public school attended by the applicant to notify the juvenile and domestic relations district court (within whose jurisdiction the applicant resides) when the applicant has had 10 or more unexcused absences from school on consecutive school days.

If a Special Indicator Request is checked on this application, I request on behalf of the applicant that it be shown on the learner's permit/driver's license. I certify that the statements made and the information submitted by me are true and correct.

I authorize issuance of an ID card. I certify that the applicant is a resident of Virginia. If a Special Indicator Request is checked on this application, I request on behalf of the applicant that it be shown on the identification card.

I certify that the statements made and the information submitted by me are true and correct.

APPLICANT UNDER AGE 18 Have you ever been found not innocent of any offense in a Juvenile and Domestic Relations Court in this or any other state?

YES

NO

If you answered YES, the court making the adjudication of “not innocent” or a court within the jurisdiction where the juvenile’s parent/legal guardian resides must provide court consent

below. COURT CONSENT In my opinion the applicant's request for a learner's permit/driver's license		should be granted.		should not be granted.
REMARKS:

SELECTIVE SERVICE

All males under the age of 26 are required to check one of the following. Failure to provide a response will result in denial of your application.

I am already registered with Selective Service.

I am a lawful non-immigrant on a current non-immigrant visa or a seasonal agricultural worker (H-2A Visa) and not required to register.

I authorize DMV to forward to the Selective Service System personal information necessary to register me with Selective Service.

By signing this application, I consent to be registered with Selective Service, if required by federal law. If under age 18, an appropriate adult must complete and sign below: I authorize DMV to send information to Selective Service which will be used to register applicant when he is 18 years old.

SIGNATURE (check one and sign)		PARENT / GUARDIAN		JUDGE, JUVENILE DOMESTIC RELATIONS COURT		EMANCIPATED MINOR

VETERAN INDICATOR

I would like to add/keep the veteran indicator on my driver's license or identification card.

I would NOT like to add/keep the veteran indicator on my driver's license or identification card.

You must complete a Virginia Veteran Military Service Certification (DL 11) form and provide an acceptable veteran service proof document to add the veteran indicator, unless you have already done so.

GOVERNMENT EMPLOYEES - (Fee waiver certification)

I certify that I am employed by the:

Commonwealth of Virginia or

City of

County of

Town of

to operate a motorcycle solely in the course of this employment and, because of such employment, I am entitled to the waiver of the motorcycle class endorsement fee, provided I have paid for and hold a valid Virginia driver's license or have made application for such.

NOTICE

Va. Code §§46.2-323 and 46.2-342 require that you provide DMV with the information on this form (including your social security number). Your personally identifiable information is being collected for record keeping purposes and will be disseminated only in accordance with Va. Code §§46.2-208, 46.2-209, and the Driver’s Privacy Protection Act, 18 USC §2721. Persons convicted of certain sexual offenses (as listed in Va. Code §9.1-902) must register or re-register with the Virginia Department of State Police as provided in Va. Code §§9.1-901, 9.1-903, and 9.1-904. If you provide a non-Virginia residence/home address or non- Virginia mailing address, your application for a driver’s license or permit may be denied. Upon issuance of a driver’s license, commercial driver's license or identification card in the Commonwealth of Virginia, any driver’s license, commercial driver's license or identification card previously issued by another state must be surrendered and will be cancelled by the issuing state.

CERTIFICATION

I certify and affirm that I am a resident of Virginia, that all information presented in this application is true and correct, that any documents I have presented to DMV are genuine, and that my appearance, for purpose of my DMV photograph, is a true and accurate representation of how I generally appear in public. I make this certification and affirmation under penalty of perjury and understand that making a false statement on this application is a criminal violation. By signing this form, I authorize DMV to verify the information provided on this application, as required to determine eligibility.