Road Test Application Form – Fill Out and Use This PDF

Class D or M Road Test Application

PARENTAL CONSENT FOR MINOR; Information & Certiication of Person Providing Consent

This section must be completed by a parent of the applicant, the legal guardian, the Massachusetts Child Guardian Division, or the Headmaster of the Boarding School the applicant is attending.

To the Registrar: I hereby certify I am: (check one)

parent

legal guardian

Massachusetts Child Guardian Division

boarding school headmaster

of the above-named applicant who is less than 18 years of age, but not less than 16 1/2 years of age, and that my consent is given as required by M.G.L. Chap. 90, Section 8 for the issuance of a Driver’s License. I further certify by my separate signature that the applicant has completed the required number of hours of behind-the-wheel driving by a validly licensed person aged 21 or over, with at least one year of driving experience, in addition to the requirements of the driver education and training program. (Sign the appropriate time period and sign again at the bottom where noted).

The applicant has completed the additional 40 hours of required supervised driving.

Parent/Guardian Signature

ompletion of Skills Program: The applicant has completed the additional 30 hours of required supervised

driving and successfully completed an RMV approved driver skills development program.Parent/Guardian Signature

False certiication is punishable by ine, imprisonment, or both (M.G.L. Chap. 90, Section 24).

	Parent/Guardian Address
	Parent/Guardian Signature	Printed Name
	If the person giving consent IS NOT a parent, proper documentation of authority must be shown.
REQUIRED INFORMATION
1. Yes No Do you have a cognitive, neurologic, physical, or any other		2. Yes No Are you currently taking any medication that may
	impairment that may affect your functional ability to operate a	affect your ability to safely operate a motor vehicle?
	motor vehicle safely?	Note: If you answered yes to questions 1, or 2 an RMV Branch
	(The Commonwealth’s medical standards for safe operation of a motor vehicle are
	found at http://www.massrmv.com/rmv/medical/policies.htm.)	Representative must contact the Medical Affairs Branch(MAB).

SIGNATURE OF APPLICANT (application not complete without signature)

Note: This application will be processed through the National Driver Register (NDR) and the Commercial Driver License Information System (CDLIS) to verify the status of operating privileges in other jurisdictions and the social security number will be veriied with the Social Security Administration.

I have reviewed this completed Application Form and swear (airm), under the penalties of perjury, that the information I have provided is true and complete. False statements are punishable by ine, imprisonment, or both (M.G.L. c 90 §24).

Signature:

Date:

The Registrar reserves the right to cancel, revoke, or recall, any permit, license, or ID card if it is determined that the applicant was not qualiied for such permit, LICENSE, OR ID CARD.

SPONSOR INFORMATION

For a Class D road test (including JOL) you must have a sponsor who its the following criteria: t least 21 years old t least one year of driving experience

alid driver’s license issued by his or her home state (including District of Columbia). Holders of foreign driver’s licenses are not eligible to be sponsors.

T21844_0215