PARENT TAUGHT DRIVER EDUCATION INSTRUCTOR DESIGNATION
SERVICES REQUEST INSTRUCTIONS
You are required to submit the "Parent-Taught Driver Education Instructor Designation Service Request" and pay the
$20.00 non-refundable fee before starting to teach a parent-taught course. Once TDLR processes the request, we will
email a parent-taught program guide to the email address listed on the form, or, if preferred, mail a physical copy to the
address provided. The purpose of the guide is to educate the instructor on the parent-taught program process.
TDLR will designate the person listed on the form as the instructor and will retain their information for verification purposes.
TDLR will provide you with a receipt number, and the student will submit that receipt number to the Texas Department of
Public Safety (DPS) when applying for the learner license, and again when applying for the provisional license.
The person who requests the Instructor Designation is considered to be the instructor unless another individual is named
on the form as the instructor. If a parent, legal guardian or judge name another individual as the instructor, both the
requestor and individual must be listed on the form. Prior to becoming a designated instructor, TDLR encourages you to
read over the Instructor Requirements to determine if you will be eligible to provide instruction.
1. Requestor InformationEnter legal name, mailing address, telephone number, email address and relationship to
student. Requestor will be considered to be the instructor of the student unless another individual is named as
instructor below. Email addresses are a part of the key information required to transact business with TDLR. Your
email address is confidential pursuant to the Texas Public Information Act and will not be shared with the public.
2. Instructor DesigneeEnter legal name of designee. (If applicable)
3. Student InformationEnter students full name and date of birth.
4. Certification StatementApplication must be signed by the instructor.
Note:
Prior to becoming a designated instructor, TDLR encourages you to read over the Instructor Requirements to determine
if you will be eligible to provide instruction.
All information and a $20.00 non-refundable fee must be submitted in order for the Department to furnish identifying
information services to the Texas Department of Public Safety regarding the designated PTDE instructor. The instructor
and or student will provide the $20.00 TDLR receipt to DPS when obtaining a learner license and provisional license. Keep
a copy of your completed application and your check or money order for your records. Do not send cash.
SEND YOUR COMPLETED APPLICATION AND $20.00 NON-REFUNDABLE APPLICATION FEE TO:
Texas Department of Licensing and Regulation
P.O. Box 12157
Austin, TX 78711-2157
For additional information and questions, please visit the TDLR website or contact us via the TDLR Help Webform
where you can submit your request for assistance and include attachments as needed.
TDLR Form DES118N rev May 2021
PARENT TAUGHT DRIVER EDUCATION INSTRUCTOR
DESIGNATION SERVICE REQUEST
1. Requestor Information:
First, Last, Middle Name, Suffix (Jr., Sr., III)
Mailing Address:
Number, Street Name, Suite Number, City, State, Zip Code
Phone Number:
Email Address:
(Area Code) Phone Number
Method of Guide Delivery: (select one) Email Mail
Relationship to Student: (select one)
Parent Grand Parent Foster Parent Legal Guardian
Step-Grand Parent Stepparent Judge with Jurisdiction over the Student
2. Instructor Designee Information:
(if applicable)
First, Middle, Last Name, Suffix (Jr., Sr., III)
3. Student Information:
Student Date of Birth:
First, Last, Middle Name, Suffix (Jr., Sr., III)
Month/Day/Year
STATEMENT OF APPLICANT
By signing this request, I certify that all information submitted on this request is true and accurate. I understand that
providing false information on this request may result in the revocation of the designation I am requesting. All information
and required fees must be submitted in order for the Department to furnish identifying information services to the Texas
Department of Public Safety regarding the designated PTDE instructor. The instructor and/or student will take the TDLR
receipt to DPS when obtaining a learner license and provisional license.
Printed Name of Instructor
Signature of Instructor
Date Signed
TDLR Form DES118N rev May 2021