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Van Familiarization Class
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Student Van Familiarization Application
Student Van Familiarization Application
Student Van Familiarization Program
Student Driver Application Questionnaire
University Department Information
Please enter the sponsoring department's information.
Supervisor/Sponsor Name
*
Required
First
Last
University Department
*
Required
Department Phone
Applicant Personal Data
Please enter student's information.
Name
*
Required
First
Last
Date of Birth
- must be mm/dd/yyyy format
*
Required
Date Format: MM slash DD slash YYYY
Banner ID
*
Required
Phone Number
Email
*
Required
Permanent Address
*
Required
Street Address
Address Line 2
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Please Read and Accept to continue
*
Required
I give my permission for the University of Mary Washington to access my driver's license record and continue to monitor it through Drive Alert, a program administered through the Virginia Department of Motor Vehicles.
Accept
Decline
Driver Record Check Declined
You must allow UMW to check your driving record through the VA DMV's Drive Alert in order to take the Van Familiarization class. Please select 'Accept' or to discontinue, close the application.
License Information (VA LICENSE ONLY)
Please check information to ensure accuracy. Incorrect information may delay scheduling.
Driver's License Number
*
Required
State
*
Required
Date Issued
- must be mm/dd/yyyy format
*
Required
Date Format: MM slash DD slash YYYY
Expiration Date
- must be mm/dd/yyyy format
*
Required
Date Format: MM slash DD slash YYYY
Any Restrictions?
*
Required
Yes
No
Restriction Description
*
Required
Total Road Experience
*
Required
Years
Months
Type of Vehicle Currently Driven
Driver History
Please check information to ensure accuracy. Incorrect information may delay scheduling.
DUI / DUID (past 2 years)
Please enter 'N/A' if this does not apply.
Reason
Date
State
Fine
Tickets (past 2 years)
Please enter 'N/A' if this does not apply.
Reason
Date
State
Fine
Accidents (past 2 years)
Please enter 'N/A' if this does not apply.
Reason
Date
State
Fine
Preferred Class Date
- must be mm/dd/yyyy format
Classes are held on Wednesdays from 4pm - 6pm. Scheduling is based on availability. If the class on the preferred date is full, you will be placed in the next available class.
Date Format: MM slash DD slash YYYY
Certification and Agreement
By signing this application to operate a Commonwealth of Virginia vehicle, I certify that:
*
Required
The information contained above is accurate
I have read, understand and agree to the UMW Policy concerning the operation of a Commonwealth of Virginia (UMW) vehicle
I agree to a DMV check and validation (Applies to all individuals operating Commonwealth of Virginia vehicles)
Electronic Signature
*
Required
By entering your name below, you are agreeing to the certification stated above.
First
Last
Name
This field is for validation purposes and should be left unchanged.
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