Form Dtp-421 - Notice Of Intent To Conduct Dmv'S 30-Hour Basic Instructor'S Course printable pdf download

Form Dtp-421 - Notice Of Intent To Conduct Dmv'S 30-Hour Basic Instructor'S Course

NOTICE OF INTENT TO CONDUCT

DMV’s 30-HOUR BASIC INSTRUCTOR’s COURSE

RIVER

RAINING

ROGRAMS

Driving School Offering Course:__________________________________________________________________________

Address of Classroom:__________________________________________________________________________________

Number of Students Enrolled:______________

AMENDED ON: ____________________

(Date)

COURSE SCHEDULE

Date

Session

Hour(s)

Location

Instructor

Driver License #

I certify that all information and other matters contained herein are true in substance and in fact. Part 76.23(a)(5) of Commissioner’s

Regulations authorizes the Department of Motor Vehicles to suspend or revoke a driving school license for “the failure of the

licensee or any partner, officer, agent or employee of the licensee to conduct the prescribed tests for instructor applicants in the

manner authorized by this department and/or the failure of the licensee or any partner, officer, agent or employee of the licensee to

conduct the 30-hour course to instructor applicants according to the curriculum supplied by this department and/or for the number

of hours required by this department and this Part.”

Print Name of Owner or Authorized Official and Title

Signature of Owner or Authorized Official

Date

This form must be submitted to DMV 30 days prior to the start date of the course. Return to:

New York State Department of Motor Vehicles

Bureau of Driver Training Programs

6 Empire State Plaza, Room 221

Albany NY 12228

Fax: (518) 473-0160

DTP-421 (6/16)

Email: Driving.School@dmv.ny.gov

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Form Dtp-421 - Notice Of Intent To Conduct Dmv'S 30-Hour Basic Instructor'S Course