CONSENT TO OBTAIN STATE MOTOR VEHICLE RECORDS
Institution:
Select
Barry University
Bolles School
Clearwater Christian College
Florida Institute of Technology
Jacksonville University
Nova Southeastern University
Palm Beach Atlantic
Ringling School of Art and Design
Saint Andrews School
Saint Edwards School
Saint Leo University
Saint Pauls School
Southeastern College
Webber International University
University of Tampa
Name:
Date of Birth:
Month/Day/Year
My current driver's license was issued in the State of:
My current driver's license number is:
(no dashes or spaces)
I have also held a driver's license in the following state(s):
I have been charged with a violation of a motor vehicle law in the following state(s):
Comments:
E-Mail of Submission Officer: