PPS 1118 06/94

PARENTAL CERTIFICATION OF CLASSROOM HOURS

FOR DRIVER EDUCATION

INSTRUCTIONS: This form is to be used by parents to certify that their child has spent a minimum of 36 clock hours completing a driver education course approved by the Virginia Department of Education for meeting the requirements of the classroom phase of the program. The form must be completed and returned to the local school division superintendent with an official transcript from the correspondence school as evidence of satisfactory completion of the course.

Student's Name

__________________________________________________

Social Security No.

__________________________________________________

Address

___________________________________________________

City, State, Zip Code

___________________________________________________

Name of Correspondence School

___________________________________________________

ATTACH AN OFFICIAL TRANSCRIPT FROM THE SCHOOL

By my signature below, I certify that the above-named student has completed at least 36 clock

hours of instructional time while working toward the completion of the course and that I am the parent of the student.

_________________

__________________________________________

Date

Signature

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Print Name