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Form Mv-278.8 Ssc - Mv-278/pre-Licensing Course Completion Certificate Order Form For Secondary Schools And Colleges

MV-278/PRE-LICENSING COURSE COMPLETION CERTIFICATE

ORDER FORM FOR SECONDARY SCHOOLS AND COLLEGES

dmv.ny.gov

PLEASE PRINT CLEARLY IN BLUE OR BLACK INK.

PROVIDER INFORMATION

Name of School

Mailing Address (Street and Number)

Room Number

City

State

Zip Code

Authorized Signature (Required)

Print Name and Title

Business Phone

E-Mail Address

Type of program(s) offered:

Driver Education Program

Pre-licensing Course

If your organization provides the pre-licensing course, explain how frequently this class is offered and the average number

of students per class.

________________________________________________________________________________________________

The requester’s name and signature must be listed on the Authorization and Approval form (MV-278.7) for this school.

ORDER INFORMATION

Each book contains 50 certificates (MV-278). Specify the number of books you are ordering and the payment amount included:

________ Books of Certificates @ $50 each = $_____________

Payment must be made in full (no partial payment will be accepted) and included with this form.

Payment must be made by check or money order payable to the “Commissioner of Motor Vehicles”.

DO NOT SEND CASH.

SEND COMPLETED FORM, CLASS ROSTERS AND PAYMENT TO:

NYS DEPARTMENT OF MOTOR VEHICLES

PRE-LICENSING PROGRAM

207 GENESEE STREET, SUITE 6

UTICA, NY 13501

A $35.00 FEE WILL BE CHARGED FOR EACH DISHONORED CHECK

MV-278.8 SSC (6/17)

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Form Mv-278.8 Ssc - Mv-278/pre-Licensing Course Completion Certificate Order Form For Secondary Schools And Colleges