Form Sbts-800 - Restricted Instruction Permit And Record Of Time And Lessons In The Car

ADVERTISEMENT

School____________________
Session______
Grade
Level______
SBTS-800
North Carolina Division of Motor Vehicles
(REV. 1/99)
SCHOOL BUS & TRAFFIC SAFETY SECTION
RESTRICTED INSTRUCTION PERMIT
AND RECORD OF TIME AND LESSONS IN THE CAR
This permit is valid for use only for instruction by a CERTIFIED DRIVER EDUCATION TEACHER in a DRIVER ED CAR
for students under the age of 18. Expires at End of Roadwork Session.
(Print in blue or black ink)
Name as on Birth Certificate
_______________________________________________________________________________________
Address
Tel. No.
_________________________________________________________________
________________________________
City
Zip
S.S.#
_________________________________________________
________________
__________________________________
Birth Date
HT
WT
Eye Color
Hair Color
Sex
______________________
_________
_________
__________
__________
F
M
Have you ever suffered from a seizure disorder, diabetes, heart trouble, paralysis, fainting, dizzy spells, or experienced problems with narcotics, other
drugs, or intoxicating liquor or received treatment for substance abuse?
Yes
No If yes, list problem and date of last
occurrence._______________________________________________________________
I certify that I have read the above and that the information given is true to the best of my knowledge.
Signature of Student __________________________________Signature of Parent or Guardian ______________________________________
Signature of Principal or Driver Education Teacher __________________________________________________________________________
N.C. DIVISION OF MOTOR VEHICLES USE ONLY
Eye Exam 20/40 or better L 20/
R 20/
Corrective Lenses
Yes
No Other _________________________________
Physical Condition – Shakiness
Yes
No
Hearing
Good
Poor
Extremities missing
Yes
No
Stiffness
Yes
No
Infirmities Noted
None List_________________________________________________________________________________________
Referred to Driver License Section for ____________________________________________________________________________________
Date Issued ____________________ Signature of DMV Rep. _________________________________________________ Code ___________
Class
Classroom
Driving
BTW
Grade ________ Teacher _____________________________
Grade ________ Teacher ______________________________
RECORD OF LESSONS IN THE CAR
Total
Odometer Reading
Total Time
Time
Time
Miles Driven
Date
At
At
Lesson Taught
Each
To
Each
To
Start
End
Start
End
Date
Date
Date
Date
(Please DO NOT SIGN until you have received 6 hours of Behind-the-Wheel instruction)
The student above has received this instruction, at least 30 hours in the classroom AND at least 6 hours behind the wheel.
Signature of Student__________________________________________________________________
Date_______________________
This form should be kept on file for 2 years.
1/2/2008

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Ct-g Ext Instructions - Application For Extension Of Time To File Connecticut Group Income Tax Return - Connecticut Department Of Revenue Services Form Ct-g Ext Instructions - Application For Extension Of Time To File Connecticut Group Income Tax Return - Connecticut Department Of Revenue Services Financial
Form Ct-990t Ext Instructions - Application For Extension Of Time To File Unrelated Business Income Tax Form Ct-990t Ext Instructions - Application For Extension Of Time To File Unrelated Business Income Tax Financial
The Relationship Of Volume To Capacity In The Metric System Worksheet - Lesson 14 The Relationship Of Volume To Capacity In The Metric System Worksheet - Lesson 14 Education
The Causes And Effects Of Interactions Between Hemispheres In The 15th And 16th Century The Causes And Effects Of Interactions Between Hemispheres In The 15th And 16th Century Education
Form 7004 - Application For Automatic 6-month Extension Of Time To File Certain Business Income Tax, Information, And Other Returns Form - Department Of The Treasury Internal Revenue Service Form 7004 - Application For Automatic 6-month Extension Of Time To File Certain Business Income Tax, Information, And Other Returns Form - Department Of The Treasury Internal Revenue Service Financial
Form Gew-ta-rv-6 - Application For Extension Of Time To File The Ge/use Tax Annual Return & Reconciliation (form G-49), The Ta Tax Annual Return & Reconciliation (form Ta-2), Or The Rvst Annual Return & Reconciliation (dual Rate Form Rv-3 Form Gew-ta-rv-6 - Application For Extension Of Time To File The Ge/use Tax Annual Return & Reconciliation (form G-49), The Ta Tax Annual Return & Reconciliation (form Ta-2), Or The Rvst Annual Return & Reconciliation (dual Rate Form Rv-3 Financial
Instructions For Form It-370-pf - Application For Automatic Extension Of Time To File For Partnerships And Fiduciaries - 1998 Instructions For Form It-370-pf - Application For Automatic Extension Of Time To File For Partnerships And Fiduciaries - 1998 Financial
Form Ct-1041 Ext Draft With Instructions - Application For Extension Of Time To File Connecticut Income Tax Return For Trusts And Estates - 2014 Form Ct-1041 Ext Draft With Instructions - Application For Extension Of Time To File Connecticut Income Tax Return For Trusts And Estates - 2014 Financial
Form Gew-ta-rv-6 - Application For Extension Of Time To File The Ge/use Tax Annual Return & Reconciliation (form G-49), The Ta Tax Annual Return & Reconciliation (form Ta-2), Or The Rvst Annual Return & Reconciliation (form Rv-3) - 2010 Form Gew-ta-rv-6 - Application For Extension Of Time To File The Ge/use Tax Annual Return & Reconciliation (form G-49), The Ta Tax Annual Return & Reconciliation (form Ta-2), Or The Rvst Annual Return & Reconciliation (form Rv-3) - 2010 Financial
Form Gew-ta-rv-6 - Application For Extension Of Time To File The Ge/use Tax Annual Return & Reconciliation (form G-49), The Ta Tax Annual Return & Reconciliation (form Ta-2), Or The Rvst Annual Return & Reconciliation (form Rv-3) Form Gew-ta-rv-6 - Application For Extension Of Time To File The Ge/use Tax Annual Return & Reconciliation (form G-49), The Ta Tax Annual Return & Reconciliation (form Ta-2), Or The Rvst Annual Return & Reconciliation (form Rv-3) Financial

Related Categories

Parent category: Legal
Download
Go