Student DMV Release Form

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Purpose: To be used to give authorization to the Virginia Department of Motor Vehicles (DMV) to release commercial driver information to the Virginia Community College System (VCCS) regarding students that trained through a Virginia community college or driver training school (DTS) that has contracted with a Virginia community
college.

Instructions: Student and an Authorized Representative of the community college or DTS must complete and sign this form prior to requesting commercial driver information.Untitled Title

Student Full Name
*

Student Virginia DMV Customer Number *

Date
*

YYYY

College or DTS Authorized Representative Name *

Request and Authorization *

I request, through a Virginia community college as my representative, DMV to release to the VCCS and Virginia community colleges information relating to my driving record. If a Virginia community college has contracted with DTS to provide CDL training, testing, or both, I request, through a Virginia community college or the DTS as my representative, DMV to release information to the VCCS and Virginia community colleges. This information includes: name, date of birth, CDL number, and date issued to me. I understand that this information may be compiled in reports (CDL test results summaries), and that those summaries will contain the items of information described above. I also understand that this information may be shared by VCCS with the State Council of Higher Education in Virginia (SCHEV) for the purpose of, and in relation to, funding and tracking mechanisms for associated programming.

Yes

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