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It includes a schedule table for dates and times, tutor certification sections, applicant attestation, and legal notice about false statements under DC 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License  \n\n| \u003Cbr>Applicant Full Name\u003Cbr>(Last, First, Middle, Suffix) | Learner Permit No. |\n| --- | --- |\n|  |  |\n\nIn order to obtain your Provisional License, you must have held a valid learner permit for at least 6 months. You must not have admitted to, been liable for, or convicted of an offense for which points may be assessed for at least 12 consecutive months. You must complete and sign this Certification of Eligibility for Provisional License form certifying that you have practiced driving skills for at least 40 hours accompanied by a driver/tutor(s) who is 21 years or older with a valid full driver license, occupying the seat beside the learner and wearing a seat belt. The tutor supervising your driving must complete and sign the tutor’s information and a photocopy of their driver license must be submitted with this form. You must bring this form with you when you report for your scheduled Road Test appointment.  \n\n| Date | Tutor’s Name (Please Print) | Amount of Time | Hours/Minutes |\n| --- | --- | --- | --- |\n| \u003Cbr>Example |  |  |  |\n| 02/10/05 | Jane Doe | 8:15 am – 10:15 am | 2 hours |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n| Total Hours |  |  |  |\n\nBy signing the above certification, I, the tutor, certify that the learner has received 40 hours of driving experience specified by me on the dates and times indicated. If more than one person has tutored the learner for the 40 hours of driving, each tutor’s signature certifies only the hours for which that tutor accompanied and instructed the learner. I also certify that I meet the requirements for being a tutor.  \n\n| Tutor’s Signature |  | Date | Tutor’s Signature |  | Date |\n| --- | --- | --- | --- | --- | --- |\n|  |  |  |  |  |  |\n| Driver License No: |  |  | Driver License No: |  |  |\n| State of Issuance: |  |  | State of Issuance: |  |  |\n| Expiration Date: |  |  | Expiration Date: |  |  |\n\nI hereby certify that I am at least 16 years and 6 months old and have been a holder of a valid learner permit for at least six months, during which time I have not admitted to, been liable for or convicted of an offense for which points may be assessed. I also certify that I have received at least 40 hours of driving experience.  \n\n| Applicant’s Signature | Date |\n| --- | --- |\n|  |  |\n\nAny person who signs this form certifies that the statements that he or she is making are true. The making of a false statement on this form is a violation of DC law and subject to a fine of up to $1,000 or 180 days imprisonment or both (D.C. Official Code § 22-2405) . A false statement may be ground for denial, suspension, or revocation of an applicant’s permit.  \nVisit our website [www.dmv.dc.gov](www.dmv.dc.gov or call)[ or call](www.dmv.dc.gov or call) 311 in DC or 202-737-4404 for additional information,  \nTo report waste, fraud, or abuse by any DC Government Agency or official, call the Office of the Office of the DC Inspector General at 1-800-521-1639.  \nDMV-GRAD-HR40 Rev. 08/24/09","cbCaitGTUJ9S8mJp","https://ap.wps.com/l/cbCaitGTUJ9S8mJp","pdf",27205,"English","# Certification of Eligibility for Provisional License - 40 Hours\n## Applicant requirements\n## Tutor schedule and certification\n## Tutor qualifications and license details\n## Applicant signature and legal notice","[{\"question\":\"How long must the learner permit be held before applying?\",\"answer\":\"The applicant must have held a valid learner permit for at least 6 months to obtain a provisional license.\"},{\"question\":\"What driving experience hours are required and how must they be supervised?\",\"answer\":\"The applicant must complete and certify at least 40 hours of driving practice, accompanied by a driver/tutor who is 21 years or older and has a valid full driver license.\"},{\"question\":\"What happens if someone makes a false statement on the form?\",\"answer\":\"Signing false information violates DC law and may result in a fine up to $1,000, up to 180 days imprisonment, or both, and can lead to denial, suspension, or revocation of a permit.\"}]","Certification of Eligibility for Provisional License - 40 Hours | PDF",1790718692]