Instructions – This form is for individuals who are under 17 years age and are applying for conditional or special restricted driver’s licenses. All three parts of this form must be completed in black or blue ink (typed or printed except for signatures) and presented at a DMV office.
Applicant’s Legal Name: ________________________________________________________________________________
Address: ____________________________________________________________________________________________
Date of Birth: __________________________ Beginner’s Permit Number: _____________________ Issue Date: ________
Part 1 Certification of Driver’s Education Course (Must be completed by Certified Instructor) This section is in accordance with SC Code of Law §56-1-175 and 56-1-180.
I, _______________________________________ certify, under penalties of perjury that the above named applicant has
Legal Name of Instructor
successfully completed a driver’s education course at the school listed below.
School Name _________________________________________________________________________________________
Mailing Address _______________________________________________________________________________________
___________________________________________ |
____________________________ |
________________________ |
|
Signature of Instructor |
Certification Number |
Date |
|
|
|
|
|
Part 2 Certification of School Attendance (Must be completed by School Office Administrator or Parent/Legal Guardian if student is home schooled)
a)If the applicant has already completed high school, he may present a high school diploma or certificate, or a General Education Development (GED) Certificate in lieu of completing this section. This is in accordance with SC Code of Law §56-1-176.
b)If the applicant is home schooled a copy of one of the following documents must accompany this application:
Certificate of certification issued by the applicant’s school district or home school association.
Letter of certification issued by the applicant’s school district or home school association.
The SC Code of Law in which the home school program operates determines where the documentation should come from.
|
Home school program is operated under this SC Code of Law |
|
|
Documentation must come from |
|
|
|
|
|
|
Section 59-65-40 |
(OPTION 1) |
|
|
a district board of trustees |
|
Section 56-65-45 |
Alternative home schooling (OPTION 2) |
|
|
South Carolina Association of Independent Home Schools. |
|
Section 59-65-47 |
Associations for home schools (OPTION 3) |
|
|
Association for home schools |
As a School Office Administrator, I ______________________________________________________ certify, under penalties
Legal Name
of perjury that the above named applicant conforms to South Carolina attendance laws and regulations. The applicant is currently enrolled (or home schooled) in the school named below and is not currently suspended or expelled.
School Name: ________________________________________________________________________________________
Mailing Address: _____________________________________________________________________________________
_______________________________________ _______________________________________________ ____________
Signature of School Office AdministratorTitle of Position at SchoolDate
Part 3 Certification of Driving Practice (Must be completed by the applicant’s Licensed Parent or Legal Guardian) This section is in accordance with SC
Code of Law §56-1-175 and 56-1-180.
I, _______________________________________, driver’s license # ___________________________________ am the
Legal Name of Licensed Parent or Legal Guardian
licensed parent or legal guardian of the above named applicant. I certify that the applicant has had a minimum of 40 hours of driving practice, (including 10 during darkness) supervised by his/her licensed parent or legal guardian. I also certify under penalties of perjury, that all information included in Parts 1 and 2 were legally obtained.
____________________________________ |
__________________________________ |
________________ |
Printed Name of Licensed Parent or Legal Guardian |
Signature of Licensed Parent or Legal Guardian |
Date |
___________________________________ |
__________________________________ |
________________ |
Printed Name of Applicant |
Signature of Applicant |
Date |
