DMV Release Form

Driver Information Form

First Name

Last Name

Middle Name (Full Middle Name Required)

CWID

Driver's License Number

*Out-of-State Drivers must submit a scanned version of their license to usftravel in order to request a DMV Motor Vehicle Record. Please allow for up to 4 weeks for processing by the DMV.

Date of Birth

License Expiration Date

Department Information

Status

Student

Faculty

Student/Staff

Staff

Volunteer (Volunteer must complete a background check through Human Resources before becoming an Authorized Driver)

Graduation Term

(Ex. Spring/2016)

Title

If Faculty, include your title.

Department/class you will be driving for

Driver's Supervisor

Reason for Driving

Will you be driving a University owned vehicle?

Yes

Please fill out this Key FOB Agreement Form and return to Risk Management Office