Completion of this section is requested but not required to apply for a driver's license or ID Card. (Virginia Code §2.2-3806)
INFORMATION FOR THE DEPARTMENT OF ELECTIONS

Mail In / DMV Connect Only - Are you a citizen of the United Statesof America?

YES (INITIAL BOX)NO (INITIAL BOX)

Mail In / DMV Connect Only - Do you want to register to vote or change
your voter registration address?

YES (INITIAL BOX)NO (INITIAL BOX)INFORMATION FOR THE VIRGINIA TRANSPLANT COUNCIL
Yes, I would like to become an organ, eye and tissue donor.
DL 1P (07/01/2024)
Virginia Department of Motor Vehicles
Post Office Box 27412
Richmond, Virginia 23269-0001
www.dmv.virginia.gov

Purpose:DRIVER'S LICENSE AND IDENTIFICATION CARD APPLICATION

LOG #Use this form to apply for a driver's license, learner's permit, or identification card.

Instructions: Submit completed application to any DMV Customer Center. Complete front and back of this application.

APPLICATION TYPEREAL ID: ID requirements for domestic air travel and access to secure federal facilities change May 7, 2025. A REAL ID meets these requirements.
Would you like to apply for a REAL ID license/identification card? (Not applicable if applying for a Motorcycle Learner's Permit)
Yes - I would like to use my license/identification card as ID to board a domestic flight or enter a secure federal facility or military base on or after May
7, 2025. View the documents you'll need at dmvNOW.com/REALID or ask for a brochure.
No - I acknowledge my license/identification card will display "Federal Limits Apply" and I will need another form of ID to board a domestic flight or entera secure federal facility or military base on or after May 7, 2025.
Driver's License

Motorcycle Learner's Permit (classification not applicable)
Driver's License with School Bus Endorsement

Identification (ID) Card

Learner's Permit and Driver's License
Driver's License with Motorcycle

Driver's License Testing for Foreign Diplomats

Emancipated Minor ID Card

Hearing Impaired ID Card

(to carry less than 16 passengers)(complete Motorcycle Classification section below)

Motorcycle Only License (complete Motorcycle*Commercial Driver's License (CDL) applicants must complete the CDL Application (DL2P)Classification section below)

Motorcycle Classification
Maintaining current Virginia Motorcycle Classification
Add, Upgrade or Transfer Motorcycle Classification or obtain Motorcycle Only License. Additional testing may be required. Check applicable box below.
M 3 (3 wheels)
M (both 2 and 3 wheels)
M 2 (2 wheels)
Replacement License or Identification Card (check one of the following):
I am surrendering my current license or ID card.
I certify I cannot surrender my current license or ID card because it is:StolenDestroyed
Lost
NOTE:

APPLICANT INFORMATIONYOUR ADDRESS BELOW MUST BE CURRENT. THE U.S. POSTAL SERVICE WILL NOT FORWARD YOUR LICENSE OR ID CARD.

FULL LEGAL NAME (last, first, middle, suffix)
BIRTHDATE (mm/dd/yyyy)

SOCIAL SECURITY NUMBER (SSN)

PHONE NUMBER (optional)

SEX (check one)MALE
FEMALENON-BINARY

WEIGHT
LBS.

HEIGHTFT.

I HAVE NOT BEEN
ISSUED A SSN.

EYE COLORHAIR COLOR

IN.

STREET ADDRESS

CITY

STATE

ZIP CODE

MAILING ADDRESS (if different from above - this will show on your license/permit/ID)

CITY

STATE

ZIP CODEIF YOUR NAME HAS CHANGED, PRINT YOUR FORMERNAME HEREEMAIL ADDRESS (optional)

NAME OF CITY OR COUNTY OF RESIDENCE
CITY

COUNTY OF

1. Do you wear glasses or contact lenses to operate a motor vehicle?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Do you have a physical or mental condition/impairment which requires that you take medication? If yes, please list the condition(s) and the name of
the medication(s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Have you ever had a seizure, blackout, or loss of consciousness? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Do you have a physical condition/impairment which requires you to use special equipment to drive?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Has your license or privilege to drive ever been suspended, revoked, or disqualified in this state or elsewhere? (NOTE: You do not need to disclose if
your suspension, revocation or disqualification is due to a criminal conviction that has been expunged, or not subject to public disclosure.) . . . . . . . . . . . .
If you answered YES to any of the above provide an explanation here.
Do you currently hold or have you ever held a: (check all that apply)
If so, provide the following:

REQUIRED TESTSPASSLICENSE/ID CARD NUMBER

FAIL

Driver's License
ISSUE DATE (mm/dd/yyyy)

ID CardLearner's Permit
EXPIRATION DATE (mm/dd/yyyy)

CDL
STATE/COUNTRY

FOR DMV USE ONLY — DO NOT WRITE BELOW THIS LINE

CUSTOMER NUMBER

VISIONDL ROAD SIGNS EXAMDL KNOWLEDGE EXAM

TRANSACTION TYPE

FEE

ORIGINALREISSUEDUPLICATE

RENEWALDL SKILLSMC KNOWLEDGE
MC SKILLS M2
MC SKILLS M3

CSR SIGNATURE

CSR LOGON ID

YESNOYESNOYESNOYESNOYESNODL 1P (07/01/2024) Page 2 of 2

OPTIONAL SPECIAL INDICATORSOPTIONAL - Select relevant indicators below to show on your license, permit or ID card.
MEDICAL INDICATORS
Insulin-dependent diabetic*
Speech impairment*
Hearing impairment*
Autism spectrum disorder (ASD)*

Blind or vision impairment (ID cardonly)*Intellectual disability (IntD)*

Traumatic brain injury (DL 145
required for license or permit. A
physician statement required forID card.)* Must submit required physician statement
VETERAN INDICATOR
Add or keep the veteran indicator on my driver's license or identification card.
Remove the veteran indicator on my driver's license or identification card.
You must complete a Virginia Veteran Military Service Certification (DL 11) form and provide an acceptable veteran service proof document to add the veteranindicator, unless you have already done so.
BLOOD TYPE INDICATOR
Add or keep my blood type on my driver’s license or ID card.
Remove my blood type from my driver’s license or ID card.
Select one:
A+B+AB+O+ABABOThe blood type designation displayed on a Virginia DMV issued credential shall not create any liability on the part of the Commonwealth of Virginia. Any person orentity that takes action based on the blood type designation displayed shall indemnify and hold harmless the Commonwealth of Virginia pursuant to Va Code §§46.2-342, 46.2-345, 46.2-345.2, and 46.2-345.3.

PARENT OR LEGAL GUARDIAN CONSENT

Check applicable box, review certification statement, print your name and sign where indicated.
I authorize issuance of a learner's permit/driver's license. I certify that the applicant is a resident of Virginia. I certify that the applicant isattending school regularly and is in good academic standing, but if not, I authorize issuance of a learner's permit/driver's license. I certify that this applicant
will operate a motor vehicle for at least 45 hours (15 of which will occur after sunset) while holding a learner's permit.
If the applicant attends public school, I authorize the principal or designee of the public school attended by the applicant to notify the juvenile and domestic
relations district court (within whose jurisdiction the applicant resides) when the applicant has had 10 or more unexcused absences from school onconsecutive school days.
If a Special Indicator Request is checked on this application, I request on behalf of the applicant that it be shown on the learner's permit/driver's license.
I certify that the statements made and the information submitted by me are true and correct.

I authorize issuance of an ID card. I certify that the applicant is a resident of Virginia. If a Special Indicator Request is checked on this application, I
request on behalf of the applicant that it be shown on the identification card.
I certify that the statements made and the information submitted by me are true and correct.
PARENT/LEGAL GUARDIAN NAME (print)

PARENT/LEGAL GUARDIAN SIGNATUREDATE (mm/dd/yyyy)

APPLICANT UNDER AGE 18 Have you ever been found not innocent of any offense in a Juvenile and Domestic Relations Court in this or any other state?

YESNO
If you answered YES, the court making the adjudication of “not innocent” or a court within the jurisdiction where the juvenile’s parent/legal guardian resides must provide court consent
should be granted.
should not be granted.
below. COURT CONSENT In my opinion the applicant's request for a learner's permit/driver's license
REMARKS:JUDGE NAME (print)

JUDGE SIGNATUREDATE (mm/dd/yyyy)

SELECTIVE SERVICE

All males under the age of 26 are required to check one of the following. Failure to provide a response will result in denial of your application.
I am already registered with Selective Service.
I am a lawful non-immigrant on a current non-immigrant visa or a seasonal agricultural worker (H-2A Visa) and not required to register.
I authorize DMV to forward to the Selective Service System personal information necessary to register me with Selective Service.
By signing this application, I consent to be registered with Selective Service, if required by federal law. If under age 18, an appropriate adult must complete andsign below: I authorize DMV to send information to Selective Service which will be used to register applicant when he is 18 years old.
SIGNATURE (check one and sign)

PARENT / GUARDIANJUDGE, JUVENILE DOMESTIC RELATIONS COURTEMANCIPATED MINOR

GOVERNMENT EMPLOYEES - (Fee waiver certification)
Commonwealth of Virginia orCity ofCounty ofTown ofI certify that I am employed by the:to operate a motorcycle solely in the course of this employment and, because of such employment, I am entitled to the waiver of the motorcycle classendorsement fee, provided I have paid for and hold a valid Virginia driver's license or have made application for such.

NOTICEVa. Code §§46.2-323 and 46.2-342 require that you provide DMV with the information on this form (including your social security number). Your personallyidentifiable information is being collected for record keeping purposes and will be disseminated only in accordance with Va. Code §§46.2-208, 46.2-209, and theDriver’s Privacy Protection Act, 18 USC §2721. Persons convicted of certain sexual offenses (as listed in Va. Code §9.1-902) must register or re-register with theVirginia Department of State Police as provided in Va. Code §§9.1-901, 9.1-903, and 9.1-904. If you provide a non-Virginia residence/home address or nonVirginia mailing address, your application for a driver’s license or permit may be denied. Upon issuance of a driver’s license, commercial driver's license oridentification card in the Commonwealth of Virginia, any driver’s license, commercial driver's license or identification card previously issued by another state mustbe surrendered and will be cancelled by the issuing state.

CERTIFICATIONI certify and affirm that I am a resident of Virginia, that all information presented in this application is true and correct, that any documents I have presented toDMV are genuine, and that my appearance, for purpose of my DMV photograph, is a true and accurate representation of how I generally appear in public. I makethis certification and affirmation under penalty of perjury and understand that making a false statement on this application is a criminal violation. By signing thisform, I authorize DMV to verify the information provided on this application, as required to determine eligibility.
APPLICANT NAME (print)

APPLICANT SIGNATUREDATE (mm/dd/yyyy)