Form Hs 1 - Parental Authorization Application
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1Home-Schooled In-Car Driver Education
HS 1 (07/26/2016)
PARENTAL AUTHORIZATION
APPLICATION
Purpose:
Use this form to apply for authorization to conduct in-car driver education for your child. Pursuant to
Virginia Code § 22.1-205, the parent/legal guardian of a home-schooled minor may provide in-car instruction
to the child, provided the child meets the requirements for home school instruction under Virginia Code
§§ 22.1-254(B) or 22.1-254.1.
Instructions:
1. Complete this form in ink or type;
2. Attach a copy of either:
- The notification to the school division superintendent/designee of your intent to home-school the child,
OR
- A letter from the school division superintendent/designee acknowledging that the child is home-
schooled;
3. Attach the original proof of completion of the classroom portion of the driver education program;
NOTE: If your child is under age 18 in Planning District 8 (counties of Arlington, Fairfax, Loudoun, and
Prince William and the cities of Alexandria, Fairfax, Falls Church, Manassas, and Manassas Park), you
must also include form DEC 1 or form DTS 90 as proof of completion of the additional 90-minute parent/
student driver education component.
4. Mail this form and attachments to the Commercial Licensing Work Center at the address above.
STUDENT
STUDENT FULL LEGAL NAME (print) (last)
(first)
(middle) (suffix)
BIRTHDATE (mm/dd/yyyy) VA LEARNER'S PERMIT NUMBER
PARENT/LEGAL GUARDIAN
PARENT/LEGAL GUARDIAN FULL LEGAL NAME (print) (last)
(first)
(middle)
(suffix)
PRINCIPAL RESIDENCE ADDRESS (street)
CITY
STATE
ZIP CODE
TELEPHONE NUMBER
VA DRIVER'S LICENSE NUMBER
MOTHER
FATHER
LEGAL GUARDIAN
(
)
CERTIFICATION
I request authorization to provide in-car instruction to my home-schooled child. I certify that the vehicle that will be used to provide training
is covered by an insurance policy that provides the minimum coverage as required by Virginia Code § 46.2-472 and I give consent to DMV
to review and monitor my driving record throughout the authorization period and until my child successfully completes the DMV
administered road skills test. I further certify and affirm that all information I have presented in this form is true and correct, that any
documents I have presented to DMV are genuine, and that the information included in all supporting documentation is true and accurate. I
make this certification and affirmation under penalty of perjury and I understand that knowingly making a false statement or representation
on this form is a criminal violation.
DATE (mm/dd/yyyy)
PARENT/LEGAL GUARDIAN SIGNATURE
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