Home School Drivers Education Affidavit

MINNESOTA DEPARTMENT OF PUBLIC SAFETY Driver and Vehicle Services Visit us: drive.

Home School Driver's Education Affidavit

Submit by mail: Driver and Vehicle Services, 445 Minnesota Street, Suite 176, St. Paul, Minnesota 55101 Submit by email: driver.education@state.mn.us Submit by fax: 651-296-5316

This affidavit cannot be accepted more than 30 days before your child's 15th birthday.

I certify that my child is currently receiving full-time instruction in a home school within the meaning of Minn. Stat. ?? 120A.22 and 120A.24, and is working toward a home school diploma, and has completed a minimum of 30 hours of driver training classroom instruction using materials approved by the commissioner of public safety pursuant to Minn. Stat. ? 171.05.

Student's Full Legal Name: First

Student's Date of Birth: Name of approved classroom materials used: Parent's Name: Email Address: Street Address: City: Phone Number: Name of School District: School District Phone Number:

Middle

Last

State:

Zip Code:

PS33135-06 (12/2020)

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What is the purpose of supplying the requested information? The Department of Public Safety ("DPS") collects the information on this form for identification purposes, to verify home school instruction and the Minnesota Government Data Practices Act, Minn. Stat. ? 13.04(2).

Am I required to provide the requested information? You are not legally required to complete this form.

What will happen if I do not provide the requested information? If you do not provide this information, DPS cannot verify your home school status and will not be able to accept your submission of completing classroom driver education.

Who will have access to the requested information? DPS may disclose personal information when it relates to the operation or use of a vehicle or to public safety. The use of personal information relates to public safety if it concerns the physical safety or security of drivers, vehicles, pedestrians, or property. Information on an individual provided to verify home school status may be treated as provided by 18 U.S.C. ? 2721 and the Minnesota Government Data Practices Act, Minn. Stat. Ch. 13 and is subject to the disclosure in accordance with these laws.

I consent to the verification of the above-mentioned student's home school status with the above-mentioned resident school district by telephone or other electronic means. I acknowledge that making false statements in this document is unlawful and is subject to sanctions pursuant to Minn. Stat. ?? 171.17, 171.22 and other relevant laws.

Parent's Signature

Date:

PS33135-06 (12/2020)

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For office use only:

Date processed: Approved by:

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