Form Sf-1256 - Certification Of 50 Hours Behind The Wheel Driving Experience
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1TENNESSEE DEPARTMENT OF SAFETY AND
HOMELAND SECURITY
DRIVER SERVICES DIVISION
CERTIFICATION OF 50 HOURS BEHIND THE WHEEL DRIVING EXPERIENCE
PLEASE PRINT ALL INFORMATION CLEARLY IN BLACK INK
NAME OF PERMIT HOLDER:
TENN PERMIT NUMBER:
SOCIAL SECURITY NUMBER:
STREET ADDRESS
CITY
STATE
ZIP CODE
NAME OF PARENT, GUARDIAN OR LICENSED INSTRUCTOR:
DRIVER LICENSE NUMBER:
SOCIAL SECURITY NUMBER:
ADDRESS
CITY
STATE
ZIP CODE
I affirm that I am the above named parent/guardian or licensed instructor, and I certify that the above named permit holder (under the age of 18) has
completed fifty (50) hours of behind the wheel driving including a minimum of ten (10) hours of driving at night.
X________________________________________________________ Relationship to Permit Holder: ____________________________________
Signature of parent, guardian or licensed instructor
(Parent, Step-Parent, legal guardian)
PD
Level 1
Level 3
Level 2
At least 6 Months
At least 12 Months
Until Age 18
Learner Permit
Intermediate Restricted
Intermediate Unrestricted
Regular Class D
Class PD
● At least 15 years old
● At least 16 years old
● At least 17 years old
● At least 18 years old
NEEDS:
● Vision Exam
● Must have held a valid PD
● Held a valid Restricted
● OPTIONAL: Can apply
● Knowledge Test
for a minimum of 6 months
Intermediate for 1 Year
For a duplicate license,
● SF‐1010 Form
● Certification of 50 hours
● CANNOT have:
without the word
(Proof of Compulsory
behind the wheel experience,
*6 or more points on driving
"intermediate"
School Attendance &
including 10 hours at night
*have an at‐fault traffic crash
on its face
Satisfactory Progress)
● CANNOT have:
*have a 2nd seatbelt violation
● Parent or legal guardian
*6 or more points on driving record (this will add a 90 day waiting
must sign Teenage Affidavit
during the 180 days immediately
period to the end of the one year
of Financial Responsibility
preceding application
Intermediate Restricted duration)
● Certified Birth Certificate
● Vision Screening
● Proof of U.S. Citizenship or ● Road Skills Test
Lawful Permanent Resident
Status
FEES:
$10.50, any age under
Age 16 =$24.50
Age 17 = $2.00
$8.00 or $12.00 regular
18 years old
Age 17 =$21.00
Age 18 = Eligible for regular driver duplicate fee depending
Age 18 ‐ Eligible for regular
license at regular license fees
upon if 1st or subsequent
driver license at regular
($8.00 duplicate fee if had
duplicate license
license fees.
Intermediate license)
SAME EXPIRATION
SAME EXPIRATION
ISSUED FOR:
12 MONTHS
UNTIL AGE 21
DATE AT AGE 21
DATE AT AGE 21
RESTRICTIONS: ● Must have licensed driver
● Only one passenger
● Safety belts mandatory for all
● No restrictions
age 21 or older in front seat
● Cannot drive between 11:00 PM passengers age 4 through
and license looks
● Cannot drive between
and 6:00 AM
17 (or child restraint device
Like “Under 21”
10:00 PM ‐6:00 AM
● Safety Belts mandatory for all
if under age 4)
license
● Safety Belts mandatory for passengers age 4 through
● No additional restrictions but
all passengers age 4 through
17 (or child restraint device
license still states "intermediate"
17 (or child restraint device
if under age 4)
on the front of license
if under age 4)
SF-1256 (02/13)
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