Georgia Department of Technical and Adult Education

Technical College System of Georgia

Office of Adult Education

CERTIFICATE OF ADULT EDUCATION ATTENDANCE

Implementation Date: July 1, 2008

Use this form as a certificate of attendance when making an initial application for a driver’s license OR as proof of enrollment when seeking reinstatement of a license. Submit this original form to a Department of Driver Services (DDS) customer service center within thirty (30) days.

Student’s Full Legal Name:

___________________________________________________________________________

(Last) (First) (Middle)

Gender: _______ Date of Birth: ________________

Student’s Address: __________________________________________________________

__________________________________________________________

Adult Education Program: _______________________________________________________

Address: ________________________________________________________________

________________________________________________________________

Contact Phone: ______________________________________________________________

Submitted by (Adult Education Staff only):

Name: ______________________________________________________________________

Title: _______________________________________________________________________

Signature: ________________________________________ Date: __________________

This record is to certify that the above named student is enrolled in an adult education program and has met the attendance and the enrollment requirements of this organization. Only an Adult Education Director (or his/her equivalent) may certify this form.

Certifying Official (print name): ___________________________________________________

Official’s Title: ________________________________________________________________

Official’s Email Address: ________________________________________________________

Signature: ________________________________________ Date: __________________