Fillable Form Dmv-301 - Certification Of Attendance printable pdf download

Reno/Sparks/Carson City (775) 684-4DMV (4368)

Las Vegas Area (702) 486-4DMV (4368)

Rural Nevada (877) 368-7828

Website:

Certification of Attendance

(NRS 392)

This form is used for the purpose of a person between the ages of 14 and 18 years, and is enrolled in school, to obtain an instruction

permit or driver’s license.

This form certifies that the person is either meeting or exempt from Nevada school attendance

requirements. This form is also used by the schools to suspend a student’s instruction permit or driver’s license or deny future

privileges if the student is declared as a habitual truant. This form is only valid 60 days from which it is signed and dated.

Student Information

(

MUST BE COMPLETED)

LAST NAME

FIRST NAME

MIDDLE NAME

(PRINT)

DATE OF BIRTH

DRIVER’S LICENSE/INSTRUCTION PERMIT # (If applicable)

STUDENT ID #

PRIMARY PHYSICAL ADDRESS

SECTION 1 –

SCHOOL USE ONLY. This section is for students who are meeting school attendance requirements.

I, ___________________________________, am the Principal or designated official of _________________________________,

Principal or School Official’s Full Name

Name of School

hereby attest that _________________________________________ is in compliance with the minimum attendance requirements

Student’s Full Name

pursuant to NRS 392.122.

__________________________________

School Official’s Printed Name

School Official’s Signature and Date

SECTION 2 –

This section is for students who have attended school but are exempt from school attendance requirements.

I, the undersigned, certify that ___________________________________, whose relationship to me is _____________________,

is exempt from meeting Nevada school attendance requirements as prescribed in NRS 392.050-392.070.

__________________________________

Parent or Legal Guardian’s Printed Name

Parent or Legal Guardian’s Signature and Date

I am exempt from meeting Nevada attendance requirements because I have received one of the following documents:

 Diploma

 Certificate of High School Equivalency (GED, HiSET, or TASC)

When applying for an instruction permit or driver’s license you must present this form and a copy of the document selected above.

__________________________________

Student’s Printed Name

Student’s Signature and Date

SECTION 3 –

SCHOOL USE ONLY. This section is used by the school for the purpose of suspending or denying the driving

privileges of a student that has been declared a habitual truant.

If the student is declared a habitual truant pursuant to NRS 392.140 then the student must surrender his/her license to the school

principal or designee. If the student does not have a driver’s license then the future privileges of the student will be denied until

the student is deemed eligible for an instruction permit or driver’s license.

Select the offense and duration of suspension below:

______ First Offense –  Driver’s license suspended for _______ days (minimum of 30 days but not more than six months)

 Issuance delayed for 30 days

______ Second or Subsequent Offense -  Driver’s license suspended for _______ days (minimum of 60 days but not more

than one year)

 Issuance delayed for 60 days

This form must be sent no later than five days after issuing this order,

Driver’s License Review

please mail the completed form and student’s driver’s license to:

555 Wright Way

Carson City, NV 89711-0400

_____________________________________

School Principal or School Designee’s Printed Name, Agency and Phone Number

School Principal or School Designee’s Signature and Date

DMV-301 (12/2014)

Form Dmv-301 - Certification Of Attendance

Related Articles

Related forms

Related Categories