New York State Department of Motor Vehicles
CERTIFICATION OF SUPERVISED DRIVING
Driver license applicants who have a junior learner permit (DJ or MJ) must present this completed certificate to the Motor Vehicles License Examiner at the road test. Applicants must have completed at least 50 hours of supervised driving, including 15 hours after sunset. Supervised driving hours completed in a certified Driver Education Course are considered part of the required 50 hours and may be certified on the back of this form. Learner Permit Applicant Name ___________________________________________________________I
D Number ________________________ Address ____________________________________________________________
______________________________________ NOTE to parent/guardian of junior driver(s): You have the right to withdraw the consent you granted when the junior driver named above applied for a driver permit/license. You may do so by submitting a completed MV-1W (Withdrawal of Consent) to DMV. By submitting the MV-1W, you will be canceling the applicant’s class DJ or MJ license/permit. CERTIFICATION I certify that I am the parent or guardian of the applicant named above. I also certify that the applicant has completed at least 50 hours of supervised driving, including 15 hours after sunset. I understand that some or all of the required supervised driving hours may have been completed with a licensed driving school instructor or driver education teacher, and that these hours may be certified on the reverse side of this form. I certify that any supervised driving hours that were not completed with a licensed driving school instructor or driver education teacher were completed: 1) under the immediate supervision of a person at least 21 years of age who holds a license that is valid in New York State to operate the type of vehicle that was used, and 2) in compliance...