AL DMV Enrollment Verification

ALABAMA LAW ENFORCEMENT AGENCY ENROLLMENT / EXCLUSION FORM

To Implement Sections 16-28-40 through 16-28-45. Code of Alabama, 1975
Type all information as it should appear on your form. Please remember to capitalize.

This form will NOT be processed unless your enrollment for the current school year has been confirmed.
Student Sex
Student Last Name
Student First Name
Middle Initial ONLY
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Street
City
State
Zip
Parent Email
example@example.com
Requesting Parent Name

First NameLast Name
Parent Driver's License Upload (for verification of identity)

Cancelof
Discipline Points
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
My Products
prevnext( X )
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