Motor Vehicle Administration 6601 Ritchie Highway, N.E. Glen Burnie, Maryland 21062 DL-300 (09-07) Learner’s Permit School Attendance Certification Section A: Must be completed prior to giving form to School Official or Home Schooling Coordinator Section B: Must be completed by School Official or Home Schooling Coordinator Section A: Applicant Maryland State law requires all applicants for a Maryland learner’s permit, under the age of 16, to demonstrate acceptable school attendance in the prior school semester. This form must be completed and submitted to the MVA as part of the application process. This form applies to public, private and home school students. To be completed by the Applicant: 1. Printed Last Name of Applicant 2. Printed First Name of Applicant 9. Date of Birth (mm-dd-yyyy) 4. Printed Suffix of Applicant 6. City or County 5. Residence Street Address 3. Printed Middle Name of Applicant 8. Zip Code 7. State 10. Name & Address of Public, Private or Home School Applicant’s Signature Date Parent’s or Guardian’s Signature Date Section B: School Official/Home Schooling Coordinator To be completed by School Official/Home Schooling Coordinator: 11. Printed Name of School Official or Home 12. Printed Title of School Official or Home 13. Telephone Number (With Area Code) of Schooling Coordinator Completing Certificate Schooling Coordinator School Official or Home Schooling Coordinator Please read and check the appropriate box: 1. Is the above named applicant home schooled?.................................................................................... (If YES, proceed to boxes 14 and 15) (If NO, proceed to question 2 and complete boxes 14 and 15) YES NO 2. Does the applicant named above have 10 or less unexcused absences during the prior school semester? ....................................................................................................................... (If YES, complete boxes 14 and 15, Applicant is eligible to apply for a learner’s permit) (If NO, complete boxes 14 and 15, Applicant is not eligible for a learner’s permit) YES NO The information I have provided on this certification is true, complete, and correct to the best of my knowledge, information and belief. 14. School Official or Home Schooling Coordinator’s Signature 15. Date Signed This form must be placed in a sealed envelope with OFFICIAL school stamp or seal over flap. The applicant must present the sealed envelope to an MVA official during the time of the learner’s permit application process. If the seal is tampered with or broken on the envelope, this certification will be null and void. This certification and envelope must contain a school stamp or seal. Please place OFFICIAL school stamp or seal in box below and across flap of envelope. Official School Stamp or Seal Only For more information, please call: 1-800-638-8347 (touch tone calls only), 1-800-950-1MVA (1682) (to speak with a customer service representative), From Out-of-State: 1-301-729-4550, TTY for the hearing impaired: 1-800-492-4575. Visit our web site at: www.marylandmva.com American LegalNet, Inc. www.FormsWorkFlow.com