License - Fill Out Packet

WHAT TO BRING TO THE DPS
Driver License Checklist

o Your permit: you have to have this for at least 6 months and be at least 16!
o DL-91A (Appendix E): Classroom Instruction Log Record, complete with all 12
modules filled out
o DL-91B (Appendix F and G): Behind-the-Wheel Instruction Log and Behind-theWheel Practice Log
o DL-90B (Appendix I): Behind-the-Wheel Instruction Affidavit
o Verification of Enrollment (VOE) Form
o DE-964 Certificate of Completion from Aceable
o Impact Texas Teen Drivers (ITTD) Certificate of Completion: take a free twohour video course at aceable.com/ittd
o DL-14A: Application for Driver License or Identification Card
o A Vehicle: Also, bring proof of financial responsibility (insurance for car being
used), a current registration sticker, a current inspection sticker, and two license
plates (for the front and back of the car).
o Glasses or Contacts: Only if you need to wear them while driving!
Dont wear high heels or flip flops. They frown upon this (for real).
Remember, stay cool. You got this!
Thanks for being part of the Aceable family!

Questions? Give us a call @ 512-522-4174 or chat online at Aceable.com
610 W 5TH STREET, SUITE 603 AUSTIN, TX 78701 ACEABLE.COM
How to fill out the PTDE Packet forms?

License
Below please find helpful notes (red) and examples (blue) on how
to fill out the PTDE packet forms. DO NOT download or use these
forms. Use your own PTDE packet. Make sure to fill out all the
required forms properly.
1. DL-91A (Appendix E): Classroom Instruction Log Record
2. DL-91B (Appendix F): Behind-the-Wheel Instruction Log - 14 hours
3. DL-91B (Appendix G): Behind-the-Wheel Practice Log - 30 hours
4. DL-90B (Appendix I): Behind-the-Wheel Instruction - Driver Education
Affidavit
5. DL-14A (Appendix M): Application for Texas Driver License or
Identification Card
Appendix E
Driver License Division
Classroom Instruction Log Record

Students Name:
Instructors Name:
Date Classroom Instruction Began:
Instructors Texas Driver License Number:
Date Classroom Instruction Completed: *TTVFEBUFPO-JDFOTF$FSUJGJDBUF
Course Number:
Name of TDLR-Approved Course (which was utilized):

"DFBCMF%SJWFST&E
NOTICE: The classroom portion of the course may not be completed in less than 16 calendar days. An instructor may not
provide more than two hours of classroom instruction in any one day.
The classroom instruction must be taught in the following module sequence, and the dates of the instruction must be recorded.
-PHPOMZIPVSTQFSEBZ
Module
Minimum Hours
Required
Module 1: Texas Driver Responsibilities Knowing Texas Traffic Laws
Module 2: Texas Driver Responsibilities Preparing to Operate a Vehicle

Module 3: Basic Maneuvering Tasks Vehicle Movements
Module 4: Driver Readiness
Module 5: Information Processing Risk Reduction
Module 6: Environmental Factors
Module 7: Distractions
6 Hours
(360 Minutes)
2 Hours
(120 Minutes)
2 Hours
(120 Minutes)
2 Hours
(120 Minutes)
2 Hours
(120 Minutes)
2 Hours
(120 Minutes)
2 Hours
(120 Minutes)
Module 8: Alcohol and Other Drugs

6 Hours
(360 Minutes)
Module 9: Adverse Conditions

Module 10: Vehicle Requirements
Module 11: Consumer Responsibility
Module 12: Personal Responsibility
TOTAL
2 Hours
(120 Minutes)
2 Hours
(120 Minutes)
2 Hours
(120 Minutes)
2 Hours
(120 Minutes)
32 Hours
(1,920 Minutes)
Hour
Hour 1
Hour 2
Hour 3
Hour 4
Hour 5
Hour 6
Hour 1
Hour 2
Hour 1
Hour 2
Hour 1
Hour 2
Hour 1
Hour 2
Hour 1
Hour 2
Hour 1
Hour 2
Hour 1
Hour 2
Hour 3
Hour 4
Hour 5
Hour 6
Hour 1
Hour 2
Hour 1
Hour 2
Hour 1
Hour 2
Hour 1
Hour 2
32 Hours
Date of Instruction
%BZ
%BZ
%BZ
%BZ
%BZ
%BZ
'JMMPVUUIFSFTU
PGUIFEBUFTBT
BQQSPQSJBUF
You will be required to present this form at the driver license office when the student applies for a learner license and provisional
license.
Concurrent Driver Education Program: The student may apply for and obtain a learner license from the Texas Department of Public Safety upon
successful completion and mastery of Module One. This must include a minimum of six hours of classroom instruction for Module One.
Block Driver Education Program: The student must complete and master all of the modules (a minimum of 32 classroom instruction hours) before
he/she may apply for and obtain a learner license from the Texas Department of Public Safety.
Under no circumstances may any behind-the-wheel instruction be permitted until a learner license has been issued to the student by the Texas
Department of Public Safety.
DL-91A (Rev. 6/12)
Appendix F
Behind-the-Wheel Instruction Log

The basic in-car observation and behind-the-wheel session must be completed by your driver education provider
or, for those registered for a parent taught course, completed by the Parent Taught Driver Education Instructor
registered with TDLR. For required behind-the-wheel instruction curriculum, locate and follow the behind-the-wheel
curriculum from your course provider.
4UVEFOUPCTFSWFTQBSFOU
In-Car Observation &
Behind-The-Wheel Session
Driver Preparation
Pre-drive, Starting, Operation,
And Post-Drive Tasks
Vehicle Movements
Date
mm/dd/yyyy
Time
(am/pm)

".

".

1.

1.
1BSFOUPCTFSWFTTUVEFOU
In-Car
Observation
Behind-theWheel
Parent Taught Instructor

Signature Only and DL #
PCTFSWBUJPOIPVST
30 minutes
30 minutes
XJMMCFEPOFXJUIUIF
TUVEFOUTPGGJDJBM
60 minutes
QBSFOUJOTUSVDUPS
60 minutes
IPVSTPGOJHIU
Driver Readiness
ESJWJOHXJMMCFMPHHFE
JO"QQFOEJY( /05
Environmental
Characteristics
and Risk Factors
UIJTMPH
60 minutes
%POPUMJTUNPSFUIBO
Distractions
60 minutes
Vehicle Movements &
Reference Points
Adverse Conditions &

Vehicle Requirements
Consumer and Personal

Responsibility
TOTAL
IPVSQFSEBZ
60 minutes
60 minutes
60 minutes
60 minutes
30 minutes
30 minutes
7 hours
7 hours
DL-91B (Rev. 6/14)
Appendix G
Behind-the-Wheel Practice Log 30 Hours

The Behind-the-Wheel Instruction Guide may be downloaded or printed from www.tdlr.texas.gov/driver/driverforms.htm
The 30 hours of behind-the-wheel practice must be completed in the presence of an adult who meets the requirements of section 521.222(d)(2),
Transportation Code before the young driver is eligible for a provisional license. Only one hour of behind-the-wheel instruction per day will count towards
the 30 hours regardless of the number of hours the student actually drives in a day.
5PCFEPOFBOZUJNFCFGPSFTVOSJTF
Students Name:
Practice Session
DL #:
Date
Getting Ready, Starting, Placing

Vehicle in Motion, and Stopping
(Recommended 2 hours)

Moving, Stopping, Steering,
Knowing Where You Are

Time
(am/pm)
Daytime
Hours

Nighttime
Hours
BOEBGUFSTVOTFU
Adults Signature and DL #
QSBDUJDFIPVSTDBOCFEPOFXJUIBOZPOF
ZFBSTPMEPSPMEFSXJUIBWBMJEESJWFSMJDFOTF
IPVSTPGOJHIUESJWJOHNVTUCFDPNQMFUFE

%POPUMJTUNPSFUIBOPOFIPVSQFSEBZ
Backing (Recommended 1 hour)

Turning, Lane Position,
and Visual Skills
Searching Intended
Parking
(Recommended 1 hour)
Turnabouts
Multiple Lane
Roadways
City Driving
Expressway/Freeway
Driving
I certify and endorse that the above record is true an correct and my student has completed 30 hours of guided practice which includes at least 10 at nighttime.
Instructors Signature (if over 18 years of age students signature)
Date
When your teenager is eligible for the provisional license you may be asked to present this log with other required documents to the Department of Public
Safety. Required documents: 1) Valid Learner License, 2) Verification of Enrollment and Attendance Form, 3) DE-964 from PTDE course providers (found
on Appendix A) which provided the driver education course, 4) The vehicle used for the Road Test must be able to pass an inspection where everything works
properly, have a valid inspection sticker, valid registration sticker, and current insurance, 5) Money to pay for license.
Appendix I
Behind-the-Wheel Instruction Driver Education Affidavit

For Class C Provisional Driver License
All information on this affidavit, except the signature, must be typed or printed in black ink. The signature must be written in
black ink.
I,
, valid driver license number
(Instructors Legal Name)
following information contained in this form is true and correct. I am the instructor of
16 years of age, whose date of birth is
, hereby certify that the
(Driver License Number)

(Students Legal Name)
, who is at least
, and who has held a Texas learner license or a Texas hardship license for at least six months.
(MM-DD-YYYY)
I further certify that I am the parent, stepparent, foster parent, legal guardian, step-grandparent, or grandparent of the above named student; I have not
been convicted of Criminally Negligent Homicide or Driving While Intoxicated; I have possessed a valid license for the preceding three years and my
license has not been suspended, revoked, or forfeited in the past three years for traffic related violations.
I further certify that I have instructed the above named student in the following Texas Department of Licensing and Regulation approved course of
instruction (mark only one area of instruction):
9 14 hours observation and in-car instruction CONCURRENT with the remainder of the 32 hours of classroom instruction
Behind the Wheel Completion Date
%BUF"QQFOEJY'
XBTDPNQMFUFE
Classroom Completion Date
*TTVF%BUFPO-JDFOTF$FSUJGJDBUF
14 hours observation and in-car instruction BLOCK; and
9 My student completed 30 hours of guided practice which included at least 10 hours of nighttime driving by an instructor that
meets the requirements of Section 521.222 (d) (2), Transportation Code.
Title of TDLR-Approved PTDE Training Course:
"DFBCMF%SJWFST&E

Course Number:
Students Texas Learner License Number:

I acknowledge that falsely certifying the information contained in this affidavit will subject me to criminal penalties under
Texas Transportation Code 521.454.
%0/05'*--0655)*44&$5*0/6/5*-:063&*/'30/50'5)&%14$-&3,
(Signature)
(Date)
Sworn to and subscribed before me this
day of
, 20
(Notary Public in and for the State of Texas/Authorized Officer)
NOTE: One affidavit is required for each instructor who taught a student in each phase of the course. If there is more than one instructor, this
form may be photocopied for use by the other instructor(s). All instructors must accompany the student when applying for a provisional license.
This affidavit must be signed either before a Driver License employee at the driver license office or before a Notary Public before coming to the
driver license office. The document(s) must be presented when the student applies for a provisional license. The definition of a qualified instructor
can be found in the PTDE Information Packet.
DL-90B (Rev. 8/15)
Appendix M
APPLICATION FOR TEXAS DRIVER LICENSE OR IDENTIFICATION CARD

NOTICE: All information on this application must be in INK.
FOR DEPARTMENT USE ONLY

RESTRICTIONS/ENDORSEMENTS
Applications held only 90 days.
DPS CANNOT REFUND PAYMENT ONCE APPLICATION IS SUBMITTED.

APPLICATION for:
X DRIVER LICENSE
ASSIGNED #
LEARNER LICENSE
COMMERCIAL DRIVER LICENSE (CDL)
IDENTIFICATION CARD
NON-RESIDENT COMMERCIAL DRIVER LICENSE
APPLICANT INFORMATION
Class (Circle)
C
0
CONTACT INFORMATION
LAST
NAME:
HOME
PHONE:
FIRST NAME:
OTHER PHONE:
MIDDLE NAME:
EMAIL:
SUFFIX:
ADDRESS INFORMATION
MAIDEN NAME:
RESIDENCE ADDRESS:
DATE OF BIRTH (mm/dd/yyyy):

SSN:
SEX: (Circle One)
MALE
EYE COLOR:
RACE/ ETHNICITY:
CITY:
STATE:
FEMALE
ZIP CODE:
HAIR COLOR:
MAILING ADDRESS:
COUNTY:
(I) American Indian/Alaska Native
(A) Asian/ Pacific Islander (B) Black (H) Hispanic (O) Other (W) White
CITY:
HEIGHT: ft.
ZIP CODE:
in.
WEIGHT: lbs.
PLACE OF BIRTH: CITY:
COUNTY:
FATHERS LAST NAME:
STATE:
COUNTY:
STATE:
COUNTRY:
MOTHERS MAIDEN NAME:
REQUIRED INFORMATION FROM ALL APPLICANTS

YES
NO
1.
Are you a citizen of the United States?
2.
If you are a US citizen, would you like to register to vote? If registered, would you like to update your voter information?
By providing my electronic signature, I understand the personal information on my application form and my electronic signature will be used for
submitting my voters registration application to the Texas Secretary of States office. Wanting to register to vote, I authorize the Department of
Public Safety to transfer this information to the Texas Secretary of State.
3.
Do you wish to donate $1.00 to the Blindness Education Screening and Treatment Program?
4.
Do you wish to donate $1.00 to the Glenda Dawson Donate Life Texas Registry?
5.
Would you like to register as an organ donor?
6.
Do you want to support Texas Veterans? If yes, please indicate your donation amount $
7.
Do you have a health condition that may impede communication with a peace officer? If yes, please list
(physician must complete form DL-101 prior to the issuance of a DL/ID).
8.
a) Do you want a Veteran designator on your driver license or identification card? (proof of Honorable discharge required; acceptable documents
are DD214/5, NGB22, VA disability letter, proof of service/verification of honorable service card)
.00
b) Are you a 60% disabled Veteran receiving compensation and want to waive the application fee? (see 8a for documents required)
9.
In the event of injury or death would you like to provide two (2) emergency contacts? If yes, please list:
a) Name
Telephone Number
Address
b) Name
Telephone Number
Address
10.
Have you ever had a Texas identification card?
11.
Have you ever had a driver license or instruction permit in Texas?
Number
12.
Have you ever had a license or instruction permit in any other state? List state(s)
Number(s)
When?
Number
When?
When?
REQUIRED INFORMATION FROM DRIVER LICENSE APPLICANTS

YES NO
DRIVING HISTORY INFORMATION
13.
Are you enrolled in or have you completed an approved driver education course?
14.
Is your driver license or driver privilege CURRENTLY or EVER been suspended, revoked, canceled, denied or disqualified in ANY state?
When?
15.
16.
Why?
VEHICLE REGISTRATION AND INSURANCE INFORMATION

Do you own a motor vehicle which is required to be registered (Texas Transportation Code Section 502.040)?
Do you own a motor vehicle which is required to have liability insurance OR other proof of financial responsibility in compliance with the
Motor Vehicle Safety Responsibility Act (Texas Transportation Code Section 601.051)?
UNITED STATES SELECTIVE SERVICE

Any male United States citizen or immigrant who is at least 18 years of age but less than 26 years of age submitting this application consents to registration with the United
States Selective Service System. You must be registered to qualify for federal student aid ( to include Pell grant), job training, federal employment, and citizenship if an
immigrant. In Texas, you must be registered to qualify for state college student aid or state employment. If convicted, failure to register with the Selective Service is a
felony punishable by up to five years in prison and/or a $250,000 fine. If not registered by age 26, you can no longer register and could permanently lose those benefits
associated with registration. For alternative options for applicants who object to conventional military service for religious or other conscientious reasons information is
available at: http://www.sss.gov/FactSheets/FSaltsvc.pdf.
Check "NO" if the

student does not have
car insurance or
registration.
DL-14A (Rev. 6/14)
APPLICATION CONTINUED ON BACK
DRIVER LICENSE APPLICANTS

Answers
to 1 through 7 below are for the confidential
use of the Department.
YES NO
MEDICAL HISTORY QUESTIONS
1.
Do you currently have or have you ever been diagnosed with or treated for any medical condition that may affect your ability to safely
operate a motor vehicle?
EXAMPLES, including but not limited to: Diagnosis or treatment for heart trouble, stroke, hemorrhage or clots, high blood pressure, emphysema (within
past two years) progressive eye disorder or injury (i.e., glaucoma, macular degeneration, etc.) loss of normal use of hand, arm, foot or leg blackouts,
seizures, loss of consciousness or body control (within the past two years) difficulty turning head from side to side loss of muscular control stiff joints or
neck inadequate hand/eye coordination medical condition that affects your judgment dizziness or balance problems missing limbs
Please explain and identify medical condition:
2.
Within the past two years, have you been diagnosed with, been hospitalized for or are you now receiving treatment for a psychiatric disorder?
3.
Have you ever had an epileptic seizure, convulsion, loss of consciousness, or other seizure?
4.
Do you have diabetes requiring treatment by insulin?
5.
Do you have any alcohol or drug dependencies that may affect your ability to safely operate a motor vehicle or have you had any episodes
of alcohol or drug abuse within the past two years?
6.
Within the past two years have you been treated for any other serious medical conditions? Please explain:
7.
Have you EVER been referred to the Texas Medical Advisory Board for Driver Licensing?
NOTICE: The information on this application is required by the Texas Driver License Act, Texas Transportation Code Chapter 521. Failure to provide the
information is cause for refusal to issue a driver license or identification card, and in some cases, cancellation or withdrawal of driving privileges. False
information could also lead to criminal charges with penalties of a fine up to $4,000.00 and/or jail.
DO
NOT SIGN BELOW UNTIL INSTRUCTED TO DO SO BY
NOTARY PUBLIC
OR
DRIVER LICENSE
EMPLOYEE.
CERTIFICATION
I do solemnly swear, affirm, or certify that I am the person named herein and that the statements on this application are true and correct. I
further certify my residence address is a (check one): (
) single family dwelling, (
) apartment, (
) motel, (
) temporary shelter. I
agree to immediately report to the Texas Department of Public Safety any changes in my medical condition which may affect my ability to safely
operate a motor vehicle. I further understand that I am required by law to report any change of name or address to the Department of Public
Safety within thirty days.
%0/05'*--0655)*44&$5*0/6/5*-:063&*/'30/50'5)&%14$-&3,
Signature of Applicant
Date
Texas law requires the Texas Department of Public Safety must provide every minor applicant (under age 18), and cosigner, for a driver license
in Texas, educational information concerning state laws relating to driving while intoxicated, driving by a minor with alcohol in the minors system, and the implied consent law. The minor applicant and the cosigner must acknowledge receipt of that information prior to issuance of any
driver license or permit.
I hereby acknowledge receipt of the information concerning DWI, the Zero Tolerance Law and the Implied Consent Law.
%0/05'*--0655)*44&$5*0/6/5*-:063&*/'30/50'5)&%14$-&3,
Minor Applicant
Parent/Legal Guardian
Date of Receipt
PARENTAL AUTHORIZATION
Required for all driver license applicants under the age of 18
I do solemnly swear, affirm, or certify that I am the person named herein, that the statements on this application are true and correct,
that the above named applicant is my ( ) child ( ) stepchild ( ) ward, and that I have legal custody of the applicant. I authorize the Department
of Public Safety to issue a Class ( ) A, ( ) B, ( ) C, or ( ) M license to said minor. The Department can access the said minors school
enrollment records from the Texas Education Agency, and a school administrator or law enforcement officer is authorized to notify the
Department if the said minor is absent from school for at least 20 consecutive instructional days.
%0/05'*--0655)*44&$5*0/6/5*-:063&*/'30/50'5)&%14$-&3,
Usual Written Signature of Parent or Guardian
Driver License Number
Date
WAIVER OF PARENTAL AUTHORIZATION

Parental Authorization waived.
%0/05'*--0655)*44&$5*0/6/5*-:063&*/'30/50'5)&%14$-&3,
Signature of Applicant
DL Employee
ACID
VERIFICATION
Sworn to and subscribed before me this
day of
Notary Public in and for the State of Texas/Authorized Officer
SOCIAL SECURITY NUMBER COLLECTION DISCLOSURE
Disclosure of your social security account number is mandatory for driver license applicants, but voluntary for identification card applicants. This information
is solicited pursuant to 42 U.S.C. 405(c)(2)(C)(i), 42 U.S.C. 666(a)(13)(A); 49 C.F.R. 383.153, Texas Family Code Section 231.302(c)(1) and Texas
Transportation Code Sections 522.021 and 521.142. The Department will use social security number information for identification purposes and will only
release the number to the Child Support Enforcement Division of the Attorney Generals Office, the U.S. Selective Service Administration, the Texas Secretary
of State and the Health and Human Services Commission for statutorily authorized purposes pursuant to Texas Transportation Code Section 521.044.

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WHAT TO BRING TO THE DPS

Driver License Checklist

Thanks for being part of the Aceable family!

610 W 5TH STREET, SUITE 603 AUSTIN, TX 78701 ACEABLE.COM

How to fill out the PTDE Packet forms?

Driver License Division

Classroom Instruction Log Record

Date Classroom Instruction Began:

Instructors Texas Driver License Number:

Date Classroom Instruction Completed: *TTVFEBUFPO-JDFOTF$FSUJGJDBUF

Name of TDLR-Approved Course (which was utilized):

Module 1: Texas Driver Responsibilities Knowing Texas Traffic Laws

Module 2: Texas Driver Responsibilities Preparing to Operate a Vehicle

Module 8: Alcohol and Other Drugs

Module 9: Adverse Conditions

Driver License Division

Behind-the-Wheel Instruction Log

Parent Taught Instructor

Adverse Conditions &

Consumer and Personal

DL-91B (Rev. 6/14)

Driver License Division

Behind-the-Wheel Practice Log 30 Hours

Getting Ready, Starting, Placing

Backing (Recommended 1 hour)

Instructors Signature (if over 18 years of age students signature)

Driver License Division

Behind-the-Wheel Instruction Driver Education Affidavit

, valid driver license number

(Instructors Legal Name)

, hereby certify that the

(Driver License Number)

Classroom Completion Date

14 hours observation and in-car instruction BLOCK; and

Title of TDLR-Approved PTDE Training Course:

Students Texas Learner License Number:

Sworn to and subscribed before me this

(Notary Public in and for the State of Texas/Authorized Officer)

DL-90B (Rev. 8/15)

APPLICATION FOR TEXAS DRIVER LICENSE OR IDENTIFICATION CARD

FOR DEPARTMENT USE ONLY

Applications held only 90 days.

DPS CANNOT REFUND PAYMENT ONCE APPLICATION IS SUBMITTED.

COMMERCIAL DRIVER LICENSE (CDL)

NON-RESIDENT COMMERCIAL DRIVER LICENSE

DATE OF BIRTH (mm/dd/yyyy):

SEX: (Circle One)

(I) American Indian/Alaska Native

PLACE OF BIRTH: CITY:

FATHERS LAST NAME:

MOTHERS MAIDEN NAME:

REQUIRED INFORMATION FROM ALL APPLICANTS

Are you a citizen of the United States?

Would you like to register as an organ donor?

Have you ever had a Texas identification card?

Have you ever had a driver license or instruction permit in Texas?

REQUIRED INFORMATION FROM DRIVER LICENSE APPLICANTS

DRIVING HISTORY INFORMATION

VEHICLE REGISTRATION AND INSURANCE INFORMATION

UNITED STATES SELECTIVE SERVICE

Check "NO" if the

APPLICATION CONTINUED ON BACK

DRIVER LICENSE APPLICANTS