Chl-78a , Original Application
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1
2Texas Department of Public Safety
HANDGUN LICENSING
Regulatory Services Division
• MUST USE MOST CURRENT FORM
ORIGINAL APPLICATION
• TYPED PREFERRED OR PRINT CLEARLY
APPLICANT
FOR DPS USE ONLY
Have you previously applied for a Texas License to Carry a Handgun and/or Qualified Instructor
Yes
Certification?
No
(REGARDLESS IF ISSUED, TERMINATED, DENIED OR STILL VALID)
I am applying for:
(*APPLICANTS FOR QUALIFIED INSTRUCTORS CERTIFICATION MUST ATTACH CHL-90)
License to Carry a Handgun only
Qualified Instructor Certification only
Both
(*SKIP APPLICATION CONDITION BELOW)
Application Condition
Active Peace Officer / TDCJ
Retired Peace Officer ($25)
Retired Judicial
Indigent ($70)
Correctional Officer / Supervision
Officer ($25)
(SEE INSTRUCTIONS
Active Military ($0)
Senior Citizen ($70)
Officer / Juvenile Probation Officer /
FOR DETAILS)
Felony Prosecutor ($0)
(60 OR OLDER
Veteran ($25)
Standard ($140)
Active Texas Military Member ($25)
AT TIME OF
Other Prosecutor ($140)
Active Judicial Officer ($25)
APPLICATION)
Retired Federal Officer ($25)
Applicant Last Name
First Name:
MI
Suffix:
(AS IT APPEARS ON DL/ID)
(IF ANY)
DL/ID State
DL/ID Number
Date of Birth
Driver License
ID Card
(2-LETTER CODE)
(MM/DD/YYYY)
Place
City
State
Country
Born outside the U.S.
*If YES, attach legal
Yes
of Birth:
(2-LETTER CODE)
or U.S. Territory?
status documentation.
No
PERSONAL IDENTIFIERS
Race
Eyes
Hair
(*MATCH DL/ID)
(*MATCH DL/ID)
Male
Gender
Asian/Pacific Islander
Black
Hazel
Bald/Unknown
Gray/Partially
Female
American Indian/Alaskan Native
Blue
Maroon
Black
Red/Auburn
Height
Ft.
In.
Black
Brown Multicolor
Blonde/Strawberry Sandy
White/Hispanic
Green
Pink
Brown
White
Weight
Lbs.
Other/Unknown
Gray
Unknown
CONTACT INFORMATION
Residence Address (Cannot be a PO Box)
City
State
ZIP Code
(2-LETTER
CODE)
Have you lived at this residence for the previous five (5) years and is this the only residence
*If NO, please complete
Yes
information for the previous five (5) years (60 months)?
and attach CHL-78B
No
Is your Mailing Address different from the Residence Address listed above?
*If YES, provide mailing
Yes
address in the space below.
No
Mailing Address (if different from Residence Address)
City
State
ZIP Code
(2-LETTER
CODE)
Applicant Home Phone Number
Applicant Work Phone Number
Applicant Email
REPORTED HISTORY
Have you ever been arrested or charged with a crime? (Regardless if pending, dismissed,
Yes
*If YES, please complete
committed as a juvenile, was long ago OR was in another state.)
and attach CHL-78C.
No
Have you ever been treated and / or admitted to a facility for drug, alcohol and / or psychiatric care; OR been
diagnosed as suffering from a psychiatric disorder or condition that causes or is likely to cause substantial
Yes
*If YES, please complete
impairment in judgment, mood, perception, impulse control or intellectual ability; OR pleaded innocent by
and attach CHL-78C.
No
reason of insanity; OR been found mentally incompetent; OR had court-ordered outpatient treatment?
I understand all fees submitted to Handgun Licensing are non-refundable and non-transferable.
I verify the information provided is true and correct, and I understand this is an official government record and any false statement made on this document
or any other supplement provided to DPS may result in criminal prosecution.
I wish to contribute to the Texas Veterans’ Assistance Fund:
Yes
No
Amount: $
(Whole dollar amount only.
Please include the donation with your application fee.)
Applicant Signature
Date
(MM/DD/YYYY)
(You may copy and paste a scanned .jpg or pdf of your signature)
Mail to:
Regulatory Services Division MSC 0245, Texas Department of Public Safety, P.O. Box 15888, Austin, Texas 78761-5888
CHL-78A (Rev. 7/16)
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