Form Pdla - Certification Of School Attendance, Driver'S Education And Driving Practice


South Carolina Department of Motor Vehicles
(Rev. 5/11)
Instructions – 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 when the applicant applies for a conditional or special restricted driver’s license.
Part 1 Certification of School Attendance
(Must be completed by School Representative or Parent/Legal Guardian if student is home schooled)
Please note: 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.
* A Home school association operating under section 59-65-47 must be listed on SC Department of Education website. A section 59-
65-47 association not listed on the website must certify that it meets all standards of section 59-65-47.
Applicant’s Name:____________________________________________________________________________________
Date of Birth:__________________________ Beginner’s Permit Number:___________________ Issue Date: ________
As a School Representative, I ______________________________________________________ certify, under penalties of
Full Name
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 Representative
Part 2 Certification of Driver’s Education Course
(Must be completed by Certified Instructor)
I, _______________________________________ certify, under penalties of perjury that the above named applicant has
Full Name
successfully completed a driver’s education course at the school listed below.
School Name ________________________________________________________________________________________
Mailing Address _____________________________________________________________________________________
___________________________________________ ____________________________ ________________________
Signature of Instructor
Certification Number
Part 3 Certification of Driving Practice
(Must be completed by Parent or a Legal Guardian)
I, _______________________________________, driver’s license # ___________________________________ am the
Full Name
licensed parent of 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 a 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 Parent or Legal Guardian
Signature of Parent or Legal Guardian
Printed Name of Applicant
Signature of Applicant


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