Class D or M Road Test Application
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A. Applicant Information
Last Name
First Name
Middle Name
Date of Birth (MM/DD/YYYY)
Current Massachusetts Learner’s Permit or Driver’s License # (if applicable)
Residential Address (Where you actually reside)
Street Apt. # City State
Zip Code
Mailing Address
(same as above)
Apt. # City State Zip Code
B. Service Type License Class:
If the person giving consent IS NOT a parent, proper documentation of authority must be shown.
I hereby certify I am: (check one)
legal guardian
Department of Children and Families
boarding school headmaster
of the above-named applicant who is less than 18 years of age, but not less than 16 1/2 years of age, and that my consent is given as required by
M.G.L. Chap. 90, Section 8 for the issuance of a Driver’s License. I further certify by my separate signature that the applicant has completed the
required number of hours of behind-the-wheel driving by a validly licensed person aged 21 or over, with at least one year of driving experience, in
addition to the requirements of the driver education and training program. (Sign the appropriate time period and sign again at the bottom where noted).
1. The applicant has completed the additional 40 hours of required
supervised driving. 1. Parent/Guardian Signature: __________________________________
2. Completion of Skills Program: The applicant has completed the
additional 30 hours of required supervised driving and successfully
completed an RMV approved driver skills development program. 2. Parent/Guardian Signature: __________________________________
False certification is punishable by fine, imprisonment, or both (M.G.L. Chap. 90, Section 24B).
Parent/Guardian Address: _________________________________________________________________________________________________
Parent/Guardian Signature: ____________________________________________ Printed Name: ________________________________________
D. Mandatory Questions
(for information on medical standards related to driver’s licenses, visit
you have a cognitive, neurologic, physical, or any
other impairment that may affect your functional ability
to operate a motor vehicle safely?
Are you currently taking any medication that may affect
your ability to safely operate a motor vehicle?
E. Sponsor Information
Registration Number
Sponsor License Number
Sponsor Signature: ____________________________________________________________ Date: _______________________
F. Examiner
Test results to be completed by Examiner
Date Examined
Please Check One
Examiner Name
Examiner ID
Pass Fail Reject
Reason for Failure or Rejection
Examiner Signature
G. Certification and Signature of Applicant
(application not complete without signature)
I have reviewed this completed Application Form and swear (affirm), under the penalties of perjury, that the information I have provided is true and correct.
I am aware that false statements are punishable by fine, imprisonment, or
both under M.G.L. Chapter 90, Section 24B.
Signature: _____________________________________ Date: ________________
The Registrar reserves the right to cancel, revoke, or recall, any permit, license, or ID card
if it is determined that the applicant was not qualified for such permit, license, or ID card.
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Do YOU have everything you need for your Road Test?
A completed ‘Class D or M Road Test Application’
If you are under 18 years of age:
Class D: The application must be signed by either: (a) a parent, (b) a legal guardian, (c) the Department of
Children and Families, or (d) a boarding school headmaster. If the person signing the application is not a parent,
proper documentation must be shown at the time of the road test to prove that the person is qualified to sign
Class M: You must successfully complete a Massachusetts Rider Education Program (MREP) basic rider course
to obtain a Class M license
A valid learner’s permit
A sponsor
Your sponsor must: (a) be 21 years of age or older; (b) have at least one year of driving experience; and (c) be duly
licensed by his/her state of residence
Class M road tests do not require a sponsor
The sponsor’s valid driver’s license available for the Road Test Examiner to review
Does YOUR VEHICLE have everything it needs to be approved for use on your Road Test?
A valid vehicle registration
A valid inspection sticker
Seating accommodations for the driver and adequate seating so that the examiner may sit next to you and your sponsor
may sit in the rear seat behind the driver
Proof of insurance coverage, for vehicles registered out of state, equal to or exceeding the Massachusetts minimum
requirements, which are $20,000/$40,000 for bodily injury and $5,000 for property damage
A parking brake within reach of the front passenger seat
Please Note: Any vehicle that does not allow the examiner unobstructed access to the parking brake cannot be
For Rental Vehicles: Your rental agreement and written permission on the rental company’s letterhead with an authorized
representative’s signature and title authorizing use of the vehicle for the road test is required