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Ptde instructor designation services request form

THIS FORM IS REQUIRED IF THE PARENT/ LEGAL GUARDIAN IS NOT THE INSTRUCTOR 2026

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The document is a Parent Taught Driver Education (PTDE) Designation Form, which allows a parent, legal guardian, or judge to designate an individual to conduct a PTDE course if they are not the instructor. It outlines the eligibility requirements for the designated instructor, including age, driving experience, and criminal record checks. The form must be signed by both the parent/guardian/judge and the designated instructor and submitted to the Department of Public Safety.

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How to use or fill out THIS FORM IS REQUIRED IF THE PARENT/ LEGAL GUARDIAN IS NOT THE INSTRUCTOR

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name in the designated field where it states 'I, (Print Parent / Legal Guardian / Judge Name)'. This identifies you as the person designating an instructor.
Next, fill in the name of the instructor designee in the field labeled 'Print Instructor Designee Name'. Ensure this individual meets all eligibility requirements outlined in the form.
Provide the driver license number of the instructor designee in the corresponding field. This is crucial for verifying their credentials.
Enter the full name and date of birth of the student who will be taking the PTDE course. Use the format MM/DD/YYYY for clarity.
Select your relationship to the student by checking either 'Parent', 'Legal Guardian', or 'Judge with jurisdiction over the student'.
Finally, sign and date both signature fields at the bottom of the form to validate your designation.

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Versions	Form popularity	Fillable & printable
2017	4.1 Satisfied (34 Votes)
2017	4.4 Satisfied (48 Votes)

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