Upshur County Schools Application For Proof of Enrollment
"Required by WV Department of Motor Vehicles for all students ages 15-18" Under the revised WV Code, 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 or you may contact the Director of Student Services and Attendance at 304-472-5480. The Driver's Eligibility Certificate is proof that the student applying to the WV Department of Motor Vehicles is in compliance with WV Code 18-8-11 and 17B-2-5 of the West Virginia Motor Vehicle Law. The purpose of this form is to verify necessary and applicable information of the student applying for the WV Driver's Eligibility Certificate (Proof of Enrollment), which is required by the WV Department of Motor Vehicles for any student age fifteen and up until they reach their eighteenth birthday.
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1. Student's First Name (Legal Name)Required to answerSingle line text
2. Student's Middle NameRequired to answerSingle line text
3. Student's Last NameRequired to answerSingle line text
4. Social Security Number (Optional)Single line text
5. Date of BirthRequired to answerDate
6. Physical AddressRequired to answerSingle line text
7. CityRequired to answerSingle line text
8. StateRequired to answerSingle line text
9. Zip CodeRequired to answerSingle line text
10. Mailing Address (if different please fill in the box below)Required to answerSingle choice
11. Telephone Number (Area Code first)Required to answerSingle line text
12. Complete Student WVEIS ID Number-Most students' numbers start with 8700XXXX, some students may have numbers that begins with something else. IT IS IMPORTANT THAT THE ENTIRE 9 DIGIT NUMBER BE WRITTEN IN THE SPACE PROVIDED.Required to answerSingle line text
13. I grant permission for my child to receive a Driver's Eligibility Certificate. I understand that it may take up two weeks or in some cases longer for the school/county to process this application, 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 they fail to meet any of the requirements set forth by WV Code 18-8-11, 17B-2-5 and the West Virginia Department of Education Policy 4150.Required to answerSingle choice
14. Parent/Guardian NameRequired to answerSingle line text
15. Relationship to StudentRequired to answerSingle line text
16. Date of ApplicationRequired to answerDate
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