SCHOOL ELECTION FORM CITATION NUMBER(S) LAST NAME FIRST NAME DRIVER’S LICENSE NUMBER MIDDLE NAME DATE OF BIRTH (CHECK EITHER BOX A, B or C) A. [ ] I am eligible and elect to attend a four (4) hour basis traffic course, pursuant to section 318.14(9) Florida Statutes, because I have not elected to attend such a course within the past twelve (12) month, or five (5) times in my lifetime. B. [ ] I am eligible and elect to attend an eight (8) hour intermediate driver improvement course, pursuant to Administrative Order No. 99-14. I am no longer eligible to attend the four (4) hour course, and I have never before elected to attend the eight (8) hour course. C. [ ] I am eligible and elect to attend a ninety (90) minute Child Restraint Offender’s Program, pursuant to Administrative Order No. 92-33, because I have never elected to attend such a program. THIS PROGRAM IS AVAILABLE ONLY IN MIAMI-DADE COUNTY. I, the undersigned, do solemnly swear or affirm that I am eligible for the option checked above. I am pleading no contest to the charge, and requesting to attend a school program. Signature Date HOW TO ENROLL IN TRAFFIC SCHOOL 1. Contact the traffic school of your choice. For a list of Traffic Schools in your area refer to the Yellow Pages of your telephone directory. 2. You must mail the SCHOOL ELECTION FORM along with your payment and the yellow copy of your citation to: CLERK OF COUNTY COURTS, TRAFFIC COURTS DIVISION P.O. BOX 02-5450, MIAMI, FL 33102-5450 3. To pre-register for the Child Restraint Offender’s Program, call within 2 weeks of course election. Registration and fee collection begin at 6 p.m. Course fee: $30.00 (Cash Only). AVAILABLE IN MIAMI-DADE COUNTY ONLY. CHILD RESTRAINT OFFENDER’S PROGRAM (Only for Child Restraint Violations) MIAMI CHILDREN’S HOSPITAL 6125 S.W. 31st. Street, Auditorium, Miami, Florida 33155, 305-663-6865 WARNING NOTICE • Failure to complete the four (4) hour Traffic School Program listed in Section (A) of the SCHOOL ELECTION FORM within 120 days of your election will cause points to be assessed against your driver’s license, suspension of your driver’s license, and the assessment of additional fines and costs. • Failure to complete the eight (8) hour Traffic School Program listed in Section (B) of the SCHOOL ELECTION FORM within 120 days or the Child Restraint Offender’s Program listed in Section (C) of the SCHOOL ELECTION FORM within 60 days will result in the court suspending your driver’s license until you complete the program. CLK/CT 901 REV. 5/03 American LegalNet, Inc. www.USCourtForms.com