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South Carolina Department of Motor Vehicles

PDLA

CERTIFICATION OF SCHOOL ATTENDANCE, DRIVER’S

(Rev. 5/11)

EDUCATION AND DRIVING PRACTICE

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:____________________________________________________________________________________

Address:____________________________________________________________________________________________

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

Date

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

Date

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

Date

___________________________________

__________________________________

________________

Printed Name of Applicant

Signature of Applicant

Date

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

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