DMV-301 (1/2018) Signatures must be originals. Photocopies are not acceptable.
Certification of Attendance (NRS 392)
This form is used for the purpose of a person between the ages of 14 and 18 years, and is enrolled in school, to obtain an instruction
permit or driver’s license. This form certifies that the person is either meeting or exempt from Nevada school attendance requirements.
This form is also used by the schools to suspend a student’s instruction permit or driver’s license or deny future privileges if the student
is declared as a habitual truant. This form is only valid 60 days from which it is signed and dated.
Student Information (MUST BE COMPLETED)
LAST NAME (PRINT)
FIRST NAME
MIDDLE NAME
DATE OF BIRTH
DRIVER’S LICENSE/INSTRUCTION PERMIT # (If applicable)
STUDENT ID #
PRIMARY PHYSICAL ADDRESS
SECTION 1 – SCHOOL USE ONLY. This section is for students who are meeting school attendance requirements.
I, ___________________________________, am the Principal or designated official of _________________________________,
Principal or School Official’s Full Name Name of School
hereby attest that _________________________________________ is in compliance with the minimum attendance requirements
Student’s Full Name
pursuant to NRS 392.122.
__________________________________ __________________________________
School Official’s Printed Name School Official’s Signature and Date
SECTION 2 – This section is for students who have attended school but are exempt from school attendance requirements.
I, the undersigned, certify that ___________________________________, whose relationship to me is _____________________,
is exempt from meeting Nevada school attendance requirements as prescribed in NRS 392.050-392.070.
__________________________________ __________________________________
Parent or Legal Guardian’s Printed Name Parent or Legal Guardian’s Signature and Date
I am exempt from meeting Nevada attendance requirements because I have received one of the following documents:
Diploma Certificate of High School Equivalency (GED, HiSET, or TASC)
When applying for an instruction permit or driver’s license you must present this form and a copy of the document selected above.
__________________________________ __________________________________
Student’s Printed Name Student’s Signature and Date
SECTION 3 – SCHOOL USE ONLY. This section is used by the school for the purpose of suspending or denying the driving
privileges of a student that has been declared a habitual truant.
If the student is declared a habitual truant pursuant to NRS 392.140 then the student must surrender his/her license to the school
principal or designee. If the student does not have a driver’s license then the future privileges of the student will be denied until
the student is deemed eligible for an instruction permit or driver’s license.
Select the offense and duration of suspension below:
______ First Offense Driver’s license suspended for _______ days (minimum of 30 days but not more than six months)
Issuance delayed for 30 days
______ Second or Subsequent Offense - Driver’s license suspended for _______ days (minimum of 60 days but not more
than one year)
Issuance delayed for 60 days
This form must be sent no later than five days after issuing this order, Driver’s License Review
please mail the completed form and student’s driver’s license to: 555 Wright Way
Carson City, NV 89711-0400
_____________________________________ _____________________________________
School Principal or School Designee’s Printed Name, Agency and Phone Number School Principal or School Designee’s Signature and Date
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas Area (702) 486-4DMV (4368)
Rural Nevada (877) 368-7828
Website: www.dmvnv.com
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