Take this form to the DPS to apply for the unrestricted license.

DRIVER EDUCATION AFFIDAVIT I, ______________________________, valid driver license number_______________________________,

(Instructors Name)

hereby certify that I am the instructor of, _________________________________,

(Students Legal Name)

a person who is legally required to successfully complete a driver training course to obtain a Class C drivers license. The students date of birth is _________________________________.
(MM-DD-YYYY)

I further certify that I have not been convicted of Criminally Negligent Homicide or Driving While Intoxicated and that I am not disabled because of mental illness. I further certify that I have instructed or am instructing my student in the following Department of Public Safety approved course of instruction: (mark only one area of instruction).

7 hours in-car instruction and 7 hours supervised practice concurrent with classroom. Approved textbook used _________________________________ 7 hours in-car instruction and 7 hours supervised practice. Other DPS-approved in-car instruction (Course 102 or 103) Title of DPS Approved Curriculum used ____________________________ The student was issued Instruction Permit # ___________________________ Driver Education Certificate, form DE-964, # ________________________
(completed at driver license office)

Course 102

B a s e d o n t h e D e p a r t m e n t o f P u b l i c S a f e t y s a d m i n i s t r a t i v e r e g u l a t i o n , t h e s k i l l s ( d r i v i n g ) t e s t w i l l b e w a i v e d f o r a t e e n a g e r w h o c o m p l e t e s b o t h t h e c l a s s r o o m a n d b e h i n d - t h e - w h e e l p o r t i o n s o f a Te x a s d r i v e r e d u c a t i o n c o u r s e . P l e a s c h e c k t h e a p p r o p r i a t e b o x ( Ye s o r N o ) t o i n d i c a t e y o u r d e s i r e t o w a i v e t h e s k i l l s t e s t . I f y o u c h e c k N O , a s k i l l s t e s t M U S T b e p a s s e d b e f o r e y o u r s t u d e n t s license will be issued. If you desire for your student to take a skills test, you should check with your local Driver License Office in advance to determine their skills test scheduling process (appointment, first come-first served, etc.)

Ye s

No

I a c k n o w l e d g e t h a t f a l s e l y c e r t i f y i n g t h e Te x a s D r i v e r E d u c a t i o n C e r t i f i c a t e , f o r m D E - 9 6 4 , i s p u n i s h a b l e a s a t h i r d d e g r e e F e l o n y, u n d e r A r t i c l e 4 4 1 3 ( 2 9 c ) , V. T. C . S . , w h i c h i n c l u d e s i m p r i s o n m e n t f o r a p e r i o d n o t t o e x c e e d f i v e y e a r s .

_____________________________________
(Signature)

______________________
(Date)

Sworn to and subscribed before me this _____ day of ________________, 20_____. ______________________________________
Notary Public in and for the State of Texas / Authorized Officer

PLEASE NOTE: One affidavit is required for each instructor who actually teaches a student in each phase of the course. i s m o r e t h a n o n e i n s t r u c t o r, t h i s f o r m m a y b e p h o t o c o p i e d f o r u s e b y t h e s e c o n d i n s t r u c t o r.

If there

If both instructors are not able to

accompany the student when applying for an unrestricted license, the affidavit for the absent instructor will need to be notarized prior to appearing in the Driver License Office. The document(s) must be presented when the student applies for an unrestricted license. Definition of a qualified instructor can be found on page VIII of the instruction packet.

DL-90B (Rev. 9/99)