Form Dl-90b - Driver Education Affidavit

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Take this form to the DPS to apply for the unrestricted license.
DRIVER EDUCATION AFFIDAVIT
I, ______________________________, valid driver license number_______________________________,
(Instructor’s Name)
hereby certify that I am the instructor of, _________________________________,
(Student’s Legal Name)
a person who is legally required to successfully complete a driver training course to obtain a
Class C driver’s license. The student’s date of birth is _________________________________.
(MM-DD-YYYY)
I further certify that I have not been convicted of Criminally Negligent Homicide or Driving
While Intoxicated and that I am not disabled because of mental illness.
I further certify that I have instructed or am instructing my student in the following Department of
Public Safety approved course of instruction: (mark only one area of instruction).
7 hours in-car instruction and 7 hours supervised practice concurrent with classroom.
Approved textbook used _________________________________
7 hours in-car instruction and 7 hours supervised practice.
X
Other DPS-approved in-car instruction (Course 102 or 103)
C o u r s e 1 0 2
Title of DPS Approved Curriculum used ____________________________
The student was issued Instruction Permit # ___________________________
Driver Education Certificate, form DE-964, # ________________________
(completed at driver license office)
B a s e d o n t h e D e p a r t m e n t o f P u b l i c S a f e t y ’s a d m i n i s t r a t i v e r e g u l a t i o n , t h e s k i l l s ( d r i v i n g ) t e s t w i l l b e w a i v e d f o r a t e e n a g e r w h o
c o m p l e t e s b o t h t h e c l a s s r o o m a n d b e h i n d - t h e - w h e e l p o r t i o n s o f a Te x a s d r i v e r e d u c a t i o n c o u r s e . P l e a s c h e c k t h e a p p r o p r i a t e b o x
( Ye s o r N o ) t o i n d i c a t e y o u r d e s i r e t o w a i v e t h e s k i l l s t e s t . I f y o u c h e c k N O , a s k i l l s t e s t M U S T b e p a s s e d b e f o r e y o u r s t u d e n t ’s
l i c e n s e w i l l b e i s s u e d . I f y o u d e s i r e f o r y o u r s t u d e n t t o t a k e a s k i l l s t e s t , y o u s h o u l d c h e c k w i t h y o u r l o c a l D r i v e r L i c e n s e O f f i c e
i n a d v a n c e t o d e t e r m i n e t h e i r s k i l l s t e s t s c h e d u l i n g p r o c e s s ( a p p o i n t m e n t , f i r s t c o m e - f i r s t s e r v e d , e t c . )
Ye s
N o
I a c k n o w l e d g e t h a t f a l s e l y c e r t i f y i n g t h e Te x a s D r i v e r E d u c a t i o n C e r t i f i c a t e , f o r m D E - 9 6 4 , i s p u n i s h a b l e a s a t h i r d d e g r e e
F e l o n y, u n d e r A r t i c l e 4 4 1 3 ( 2 9 c ) , V. T. C . S . , w h i c h i n c l u d e s i m p r i s o n m e n t f o r a p e r i o d n o t t o e x c e e d f i v e y e a r s .
_____________________________________
______________________
(Signature)
(Date)
Sworn to and subscribed before me this _____ day of ________________, 20_____.
______________________________________
Notary Public in and for the State of Texas / Authorized Officer
P L E A S E N O T E : O n e a f f i d a v i t i s r e q u i r e d f o r e a c h i n s t r u c t o r w h o a c t u a l l y t e a c h e s a s t u d e n t i n e a c h p h a s e o f t h e c o u r s e . I f t h e r e
i s m o r e t h a n o n e i n s t r u c t o r , t h i s f o r m m a y b e p h o t o c o p i e d f o r u s e b y t h e s e c o n d i n s t r u c t o r . I f b o t h i n s t r u c t o r s a r e n o t a b l e t o
a c c o m p a n y t h e s t u d e n t w h e n a p p l y i n g f o r a n u n r e s t r i c t e d l i c e n s e , t h e a f f i d a v i t f o r t h e a b s e n t i n s t r u c t o r w i l l n e e d t o b e n o t a r i z e d p r i o r
t o a p p e a r i n g i n t h e D r i v e r L i c e n s e O f f i c e . T h e d o c u m e n t ( s ) m u s t b e p r e s e n t e d w h e n t h e s t u d e n t a p p l i e s f o r a n u n r e s t r i c t e d l i c e n s e .
D e f i n i t i o n o f a q u a l i f i e d i n s t r u c t o r c a n b e f o u n d o n p a g e V I I I o f t h e i n s t r u c t i o n p a c k e t .
DL-90B (Rev. 9/99)

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