Form Dl 1p - Driver'S License And Identification Card Application
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2Completion of this section is requested but not required to apply for a driver's license or ID Card. (Virginia Code §2.2-3806)
INFORMATION FOR THE DEPARTMENT OF ELECTIONS
Are you a citizen of the United States of America?
Do you want to apply to register to vote or change your voter registration
address?
YES
NO
YES
NO
(INITIAL BOX)
(INITIAL BOX)
(INITIAL BOX)
(INITIAL BOX)
INFORMATION FOR THE VIRGINIA TRANSPLANT COUNCIL
Yes, I would like to become an organ, eye and tissue donor.
DL 1P (07/01/2016)
DRIVER'S LICENSE AND IDENTIFICATION CARD APPLICATION
LOG #
Purpose:
Use this form to apply for a driver's license or identification card.
Instructions: Submit completed application to any DMV Customer Center. Complete front and back of this application.
Note: A $5 service fee applies to each license or identification card renewal conducted in a Customer Service Center (CSC) if the transaction is
eligible to be performed by internet or mail, unless the renewal is conducted with another transaction that must be completed in person at a CSC.
APPLICATION TYPE (Check one)
Driver's License
Motorcycle Learner's Permit
Identification (ID) Card
(classification not applicable)
Driver's License with School Bus Endorsement
Learner's Permit and Driver's License
Hearing Impaired ID Card
(to carry less than 16 passengers)
Driver's License with Motorcycle
Driver's License Testing for Foreign Diplomats
Emancipated Minor ID Card
(complete Motorcycle Classification section below)
Motorcycle Only License
(complete Motorcycle Classification section below)
Motorcycle Classification
Maintaining current Virginia Motorcycle Classification
Add, Upgrade or Transfer Motorcycle Classification or obtain Motorcycle Only License. Additional testing may be required. Check applicable box below.
M 3 (3 wheels)
M (both 2 and 3 wheels)
M 2 (2 wheels)
Replacement License or Identification Card
:
I am surrendering my current license or ID card as it has been Destroyed or Mutilated
(check one of the following)
I certify I cannot surrender my current license or ID card because it is:
Lost
Stolen
Do you currently have or have you ever held a driver's license or learner's permit from another state, U.S. territory or foreign country?
Yes
No
If yes, provide the following:
LICENSE NUMBER
ISSUE DATE (mm/dd/yyyy)
EXPIRATION DATE (mm/dd/yyyy)
STATE/COUNTRY
APPLICANT INFORMATION
NOTE:
YOUR ADDRESS BELOW MUST BE CURRENT. THE U.S. POSTAL SERVICE WILL NOT FORWARD YOUR LICENSE OR ID CARD.
FULL LEGAL NAME (last, first, middle, suffix)
SOCIAL SECURITY NUMBER
BIRTHDATE (mm/dd/yyyy)
TELEPHONE NUMBER
GENDER (check one)
WEIGHT
HEIGHT
EYE COLOR
HAIR COLOR
MALE
FEMALE
LBS.
FT.
IN.
STREET ADDRESS
APT NO.
CITY
STATE
ZIP CODE
NAME OF CITY OR COUNTY OF RESIDENCE
IF YOUR NAME HAS CHANGED, PRINT YOUR FORMER NAME HERE
CITY
COUNTY OF
MAILING ADDRESS (if different from above - this address will show on your license/permit)
APT NO.
CITY
STATE
ZIP CODE
SPECIAL INDICATOR REQUEST
1. Do you wear glasses or contact lenses to operate a motor vehicle?
YES
NO
Please show the following indicator(s) on my
2. Do you have a physical or mental condition which requires that you take medication?
YES
NO
license or ID card:
Insulin-dependent diabetic
3. Have you ever had a seizure, blackout, or loss of consciousness?
YES
NO
Speech impairment
4. Do you have a physical condition which requires you to use special equipment to drive?
YES
NO
Hearing impairment (license only)
5. Have you been convicted within the past ten years in this state or elsewhere of any offense
Intellectual disability (IntD)
YES
NO
resulting from your operation of, or involving, a motor vehicle?
(Do not include parking tickets.)
Autism spectrum disorder (ASD)
6. Has your license or privilege to drive ever been suspended, revoked, or disqualified in this state or
YES
NO
Must submit required physician statement
elsewhere, or is it currently suspended, revoked or disqualified?
If you answered YES to any of the above provide an explanation here.
FOR DMV USE ONLY — DO NOT WRITE BELOW THIS LINE
REQUIRED TESTS
PASS
FAIL
CUSTOMER NUMBER
TRANSACTION TYPE
FEE
ORIGINAL
REISSUE
REPLACEMENT
RENEWAL
VISION
DL KNOWLEDGE EXAM
PROOF OF ID (primary)
PROOF OF ID (secondary)
DL ROAD SIGNS EXAM
DL SKILLS
PROOF OF SOCIAL SECURITY (specify)
PROOF OF RESIDENCY
MC KNOWLEDGE
MC SKILLS M2
PROOF OF LEGAL PRESENCE (specify)
MC SKILLS M3
Document Type
Document Number
Expiration Date (mm/dd/yyyy)
REMARKS/PAID STAMP
Document Type
Document Number
Expiration Date (mm/dd/yyyy)
Document Type
Document Number
Expiration Date (mm/dd/yyyy)
CSR SIGNATURE AND LOGONID
DOCUMENT VERIFIER SIGNATURE AND LOGONID
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