New York State Department of Motor Vehicles
CERTIFICATION OF SUPERVISED DRIVING
Driver license applicants who have a junior learner permit (class DJ or MJ) must give this completed certificate to the Motor
Vehicles License Examiner at the road test. Applicants must have driven at least 50 hours with supervision, which includes 15 hours
after sunset. The number of hours driven with supervision in a certified Driver Education Course is considered part of the required 50
hours and can be certified on the back of this form.
Applicant Name ___________________________________________________________ID Number ________________________
NOTE TO THE PARENT OR GUARDIAN OF A JUNIOR DRIVER: You can remove the consent you gave when the junior driver
described above submitted an application for a driver permit or driver license. To cancel the junior driver’s class DJ or MJ permit or
driver license, complete form MV-1W (Withdrawal of Consent) and submit the form to DMV.
I certify that I am the parent or guardian of the applicant named above. I also certify that the applicant has completed at least 50
hours of supervised driving, including 15 hours after sunset. I understand that some or all of the required supervised driving hours
may have been completed with a licensed driving school instructor or driver education teacher, and that these hours may be certified
on the reverse side of this form. I certify that any supervised driving hours that were not completed with a licensed driving school
instructor or driver education teacher were completed: 1) under the immediate supervision of a person at least 21 years of age who
holds a license that is valid in New York State to operate the type of vehicle that was used, and 2) in compliance with any regional
restrictions applicable to driving with a junior learner permit in that area. I understand that falsifying any information on this
certification may be a crime (felony or misdemeanor), punishable by a fine, imprisonment, or both.
Printed Name of Parent or Guardian
Signature of Parent or Guardian
The number of hours driven while supervised by a driving school instructor or driver education teacher can be certified in the table
below. All information provided in this table must be confirmed by records required according to the regulations of the Department of
Motor Vehicles and the State Education Department. Any false statement is a violation of section 392 of the Vehicle and Traffic Law
and is a misdemeanor.
Name of School