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Learners Permit School Attendance Certification DL-300 - Maryland

Learners Permit School Attendance Certification Form. This is a Maryland form and can be used in Motor Vehicle Administration Statewide .
 Fillable pdf Last Modified 2/23/2010
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Motor Vehicle Administration 6601 Ritchie Highway, N.E. Glen Burnie, Maryland 21062 DL-300 (09-07) Learner's Permit School Attendance Certification Section A: Must be completed prior to giving form to School Official or Home Schooling Coordinator Section B: Must be completed by School Official or Home Schooling Coordinator Maryland State law requires all applicants for a Maryland learner's permit, under the age of 16, to demonstrate acceptable school attendance in the prior school semester. This form must be completed and submitted to the MVA as part of the application process. This form applies to public, private and home school students. Section A: Applicant To be completed by the Applicant: 1. Printed Last Name of Applicant 2. Printed First Name of Applicant 3. Printed Middle Name of Applicant 4. Printed Suffix of Applicant 5. Residence Street Address 6. City or County 7. State 8. Zip Code 9. Date of Birth (mm-dd-yyyy) 10. Name & Address of Public, Private or Home School Applicant's Signature Date Parent's or Guardian's Signature Date To be completed by School Official/Home Schooling Coordinator: Section B: School Official/Home Schooling Coordinator 11. Printed Name of School Official or Home 12. Printed Title of School Official or Home 13. Telephone Number (With Area Code) of Schooling Coordinator Completing Certificate Schooling Coordinator School Official or Home Schooling Coordinator Please read and check the appropriate box: 1. Is the above named applicant home schooled?.................................................................................... (If YES, proceed to boxes 14 and 15) (If NO, proceed to question 2 and complete boxes 14 and 15) 2. Does the applicant named above have 10 or less unexcused absences during the prior school semester? ....................................................................................................................... (If YES, complete boxes 14 and 15, Applicant is eligible to apply for a learner's permit) (If NO, complete boxes 14 and 15, Applicant is not eligible for a learner's permit) YES NO YES NO The information I have provided on this certification is true, complete, and correct to the best of my knowledge, information and belief. 14. School Official or Home Schooling Coordinator's Signature 15. Date Signed This form must be placed in a sealed envelope with OFFICIAL school stamp or seal over flap. The applicant must present the sealed envelope to an MVA official during the time of the learner's permit application process. If the seal is tampered with or broken on the envelope, this certification will be null and void. This certification and envelope must contain a school stamp or seal. Please place OFFICIAL school stamp or seal in box below and across flap of envelope. Official School Stamp or Seal Only For more information, please call: 1-800-638-8347 (touch tone calls only), 1-800-950-1MVA (1682) (to speak with a customer service representative), From Out-of-State: 1-301-729-4550, TTY for the hearing impaired: 1-800-492-4575. Visit our web site at: www.marylandmva.com American LegalNet, Inc. www.FormsWorkFlow.com
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