CALHOUN COUNTY SCHOOLS APPLICATION FOR DRIVER'S ELIGIBILITY FORM
Required by WV Department of Motor Vehicle for all students age 15 up to age 18
Complete form and Select Share and email the completed form to
You will receive an email back when your form has been processed and can be picked up.
The purpose of this form is to verify the name, and address of the student applying for the WV Driver’s Eligibility Certificate, which is required by WV Dept. of Motor Vehicles for any student age fifteen and up until they reach their eighteenth birthday.
The Driver's Eligibility Certificate is proof that the student applying with the WV Department of Motor Vehicles is in compliance with State Law 1 8-8-11 and 17B-2-5 of the West Virginia Motor Vehicle Law.
Under the revised State Law, 18-8-11, school attendance, behavior and satisfactory academic progress are conditions of licensing for the privilege of the operation of a motor vehicle. The complete WVDE Policy 4150 is available on the WVDE Website at https://wvde.state.wv.us/policies/p4150.pdf, or you may contact Kelli Whytsell, Attendance Director, Calhoun Middle/High School or call 304-354-7011 ext 14
PRINT CLEARLY
Illegiblv or poorlv written forms will not be processed
Full Legal Name of Applicant First Middle Last
Physical Address Address will be pulled from WVEIS system. Check with the school to see that your current address is entered correctly.
Mailing Address (if different)
If the same write SAME
Route or Number City/Town State Zip Code
Email Address
Student ID Number-- (This number is the also known as the Student Lunch Number. Most students' numbers start with 14000XXX, some students have numbers that begin with something else. It is important that the entire 9 digit number be written in the space provided)
COMPLETE STUDENT WVEIS ID. NUMBER
I the parent or legal guardian of
have read WVDE Policy 4150 (https://wvde.state.wv.us/policies/p4150.pdf) and hereby grant my permission for my child to receive a Driver’s Eligibility Certificate. I understand that it may take two weeks or in some rare cases longer, for the school/county to process this form, especially at the end of the school year. I further understand that my child's driving privileges may be revoked or denied by the State of West Virginia should he/she fail to meet any of the requirements set forth by West Virginia State Law 18-8-11, 17B-2-5 and the West Virginia Department of Education Policy 4150.
Print Name Relationship Signature Date of Application
I applicant for a Driver's Eligibility Certificate have read WVDE Policy 4150 and wish to
(Student Signature)
receive a Driver's Eligibility Certificate.