Driving Privilege Reinstatement Application Waiting List Form

By accessing this application form, you agree to be bound by the website’s terms and conditions. You also agree to be contacted via email, phone, or text by our staff.

This application form requires you to provide certain information (name, home address, valid email address, etc.) to allow us to retrieve your Internet Secretary of State (SOS) driving record and assess your driving record for reinstatement.

You must be 18 years or older to use and/or complete this form. Your information will be kept confidential and will not be shared with third parties, other than those who assist us in operating our website, conducting our business, or servicing you, as long as those parties agree to keep this information confidential.

You MUST enter a valid email address. If you do not have an email address, you may obtain one for free at www.gmail.com or www.yahoo.com.

Email Address (Required to check case status and receive updates)

example@example.com

How did you hear about the SEMCA Michigan Works! Driving Privilege Reinstatement program?

If selected other, please tell us how you heard about the SEMCA Driving Privilege Reinstatement program?

To be eligible for SEMCA DPR, you MUST be a current Monroe County or Out-Wayne County resident (EXCLUDES DETROIT). You must upload photos of the front AND back of your State ID, or driver's license.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

First Name - To find your record, we need to know your name AT THE TIME OF THE DRIVING OFFENSE

First_Name

Last Name - To find your record, we need to know your name AT THE TIME OF THE DRIVING OFFENSE

last_name

Please list any other aliases used (maiden name, married name, etc.)

Date of Birth (MM-DD-YYYY)

Date

Race - Race is required to confirm your Secretary of State driving record

Gender at Birth

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Please type in your most recent Drivers License Number.

Are you currently Married?

Annual Household Income

Please enter your average household yearly income

Number of people in household (including yourself):

Please include all dependents that you financially support, including spouse.

What is your current employment situation?

Are you receiving Cash Assistance?

Are you currently on Medicaid?

Are you receiving Unemployment?

Are you receiving MRS (Michigan Rehabilitation Services)?

Driver's License Endorsement - Do you have a Chauffeur or Commercial Driver's License?

Is your license suspension due to Failure to Comply with Judgement (ie. not paying fines/costs), or due to Failure to Appear in Court?

Is your license currently suspended due to alcohol or drug related driving offenses?

How has having a suspended license been a barrier for employment, maintaining employment, or finding better employment? You MUST write a sentence or two here for explanation or your application will be DENIED.

Please list the counties in which your driving offenses took place. For example, Wayne County, Monroe County, Oakland County, etc. If you do not know the county, please list the city.

Please upload photos of the front AND back of your driver's license, or state ID. Your ID is required so we can verify your identity and residency. Your ID must be VALID(not expired). Your photo ID must contain a Monroe County address.

Application Status

Denial Reason (Pick One)

Reason for Being {Application Status}

Current status of applicaiton for {lastName}:

{applicationStatus}

Reason for Denial: {denialReason}

Additional Information: {reasonFor23}

CS Email

example@example.com

Account ID

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Driving Privilege Reinstatement Application Waiting List - 2026 BRES