AOC-299 Rev. 11-97 Commonwealth of Kentucky High School Enrollment Verification/School District Not Participating/Home Schooling Verification K.R.S. 159.051-No Pass / No Drive Statute & K.R.S. 186.470 K.R.S. 159.051 and 186.470 pertains to any applicant under the age of eighteen (18) years of age. To receive 1. 2. 3. 4. a permit you must bring to the Circuit Clerk's Office the following: This completed school enrollment verification form or home schooling enrollment verification form. An original or certified copy of your birth certificate. Your signed social security card. In addition, a parent or legal guardian must be present when applying to give their consent. (To be Completed By Student (please print all information) Student Information: Name _____________________________________________________ Social Security Number ________/________/________ Last First Middle Date of Birth _________/_________/_________ month day School _________________________________________________ year Address _________________________________________/_____________________/__________________/_______________ Number City State Zip Address of School __________________________________________________ School District _________________________ City If Applicant is being home schooled: State Parent or Guardian's full name ____________________________________________ Parent or Guardian's address _____________________________________________ Address ____________________________________________ City State Zip Do Not Write Below This Line. This Section Is To Be Completed By School Official. To Be Official, The School Seal Must Be Affixed To This Form. For Options A & B To the _________________________________ Circuit Clerk County (Note: Fill Out Only That Section Which Is Applicable To You.) u High School Enrollment Verification. A. I certify that ___________________________________________________ is currently enrolled or has been enrolled in the prior Student Name semester of school and is not or has not been found to be academically deficient. Name of School __________________________________Name of School Official (please print) _________________________ or; Signature of School Official _____________________________________________ Date ____________________________ School Seal u School Districts Not Participating B. Please be informed that _______________________________________ is currently enrolled at __________________________ Student Name Name of School located in ______________ / __________ / ____________ Name of School Official (please print) _________________________ City State County or; Signature of School Official______________________________________________ Date ____________________________ School Seal C. u Home School Verification Please be informed that ______________________________________________ is currently being schooled at home and is not currently or has not been previously been found to be academically deficient in accordance with KRS Chapter 159. Signature of Parent or Guardian ________________________________________________ Date ________________________ THIS VERIFICATION FORM IS VALID FOR 60 DAYS FROM THE DATE SIGNED BY THE SCHOOL OFFICIAL, PARENT OR GUARDIAN. Circuit Court Clerk's Use Only Has this student dropped out of school and applying for reverification? ______ YES ______ NO If yes, please submit a copy to the Division of Driver Licensing along with the license stub 2000 © American LegalNet, Inc.