Driver Improvement Waiver

DRIVER IMPROVEMENT PROGRAM

Participant Soundex Number (Driver's License Number)

Participant Name:

Participant Date of Birth:

I am participating in the Driver Improvement Program because the Maryland MVA or another state motor vehicle is requiring my participation or I am participating voluntarily.
I understand that it is preferable to provide my MVA assignment letter but it is not required.
Electronic certification of completion of this program is based solely on the accuracy of the
information I provided to the Driver Improvement Program provider on this form; and
I have been provided a copy of the Driver Improvement Program Participant Roles and
Responsibilities; and
I fully understand my responsibility in assuring that my driving record properly reflects my
completion of this program

November 21, 2024

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw your signature with your mouse, tablet or smartphone Clear

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

Timestamp

Audit

December 1, 2020 2:42 pm EST

Driver Improvement Waiver Uploaded by Premier Driving School, Inc - service@premierdriversed.com IP 100.16.3.192

February 8, 2023 4:51 pm EST

David Barnes - service@premierdriversed.com added by Premier Driving School, Inc - service@premierdriversed.com as a CC'd Recipient Ip: 100.16.3.192

February 1, 2024 1:24 pm EST

David Barnes - service@premierdriversed.com added by Premier Driving School, Inc - service@premierdriversed.com as a CC'd Recipient Ip: 100.16.3.192