Student Behind The Wheel Extension Request

Note for Students:

MVA requires your driving school to ensure you complete your ‘behind the wheel’ education within 18 weeks. However, you are entitled to ask your school for additional time by completing this form.

By signing below, I (or my Parent/Guardian if under 18) agree that I need more than 18 weeks to finish the driver education program.

School Information

Premier Driving School, Inc.
333 Kenmore Ave, Bel Air, MD 21014
School ID Number: C00154
Phone Number: 410-877-7100

Student Name:

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw Signature
Type In Signature

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I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Signed by David Barnes
Signed On: June 9, 2025

Timestamp

Audit

June 9, 2025 5:32 pm EDT

BTW Extension Request Uploaded by David Barnes - dbarnes2@premierdriversed.com IP 100.16.30.41