Skill Performance Evaluation Certificate Application Form Page 4

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SPE Certificate Application Cover Letter
U.S. DEPARTMENT OF TRANSPORTATION
Federal Motor Carrier Safety Administration
RE: Skill Performance Evaluation (SPE) Certificate Application
Dear Sir/Madam:
Enclosed is an application packet for a SPE certificate as prescribed in Section 391.49 of the Federal
Motor Carrier Safety Regulations. The medical evaluation summary must be completed by an
orthopedic surgeon or physiatrist. We recommend that you go to a rehabilitation facility for this
examination. These facilities and their personnel generally have more experience in evaluating the
limb-amputee or limb-impaired individual.
Because you are applying for a unilateral SPE certificate, it will be your responsibility to obtain a copy
of your State motor vehicle driving record, a road test and a road test certificate. The road test must
be administered by a motor carrier or a person who is competent to administer the test and evaluate
its results. The forms necessary to accomplish everything except obtain your State motor vehicle
driving record are provided as part of your SPE certificate application packet.
Please take the time to read this SPE certificate application packet very carefully. Assure that the
application packet is complete and all required additional information is attached before you submit it
for consideration. Incomplete application packets will be returned.
If you have any questions, please contact the medical program specialist in the service center for the
State in which you are a legal resident. Please return your completed SPE certificate application
packet to him/her at his/her office address. The locations of the service centers are as follows:
Service Center
Territory Included
Office Location
Eastern
CT, DC, DE, MA, MD,
802 Cromwell Park Drive,
ME, NJ, NH, NY, PA,
Suite N, Glen Burnie,
PR, RI, VA, VT, WV
MD 21061
(443) 703-2240
Midwestern
IA, IL, IN, KS,
19900 Governors Dr.,
MI, MO, MN,
Suite 210, Olympia
NE, OH, WI
Fields, IL 60461-1021
(708) 283-3569
Southern
AL, AR, FL, GA,
1800 Century Blvd.
KY, LA, MS, NC,
Suite 1700,
NM, OK, SC, TN,TX
Atlanta, GA 30345-3220
(404) 327-7371
Western
American Samoa,
1800 Century Blvd.
AK, AZ, CA, CO,
Suite 1800,
Guam, HI, ID,
Atlanta, GA 30345-3220
Mariana Islands, MT,
(404) 327-7371
ND, NV, OR, SD,
UT, WA, WY

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