Form Mv-278.5n - Mv-278 Roster And Control

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MV-278 ROSTER AND CONTROL
School Name
Class Location
Address
Date of Course
Instructor’s Name (Print or Type)
Instructor Card Number
INSTRUCTOR:
ONLY students who have a VALID LEARNER PERMIT are eligible to receive an MV-278 certificate upon completion of the course.
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If you are issuing a duplicate certificate, record the original MV-278 number, as well as the duplicate number.
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After issuing the MV-278 certificates at the end of a class session, enter the date and sign your name on the blank line below the last entry.
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Attach all voided certificates to the roster and return to DMV.
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When you request new books of MV-278 certificates, you must return the original Roster and Control sheets to your local Testing and Investigations Unit.
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Certificates must be listed in sequential order.
MV-278
Original
Certificate
Certificate Number
Client ID
Name of Student
(Duplicates Only)
(Print or Type)
Number
Number
Signature of Student
For School Use
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MV-278.5N (8/15)

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