Application for Certificate of Compulsory School Attendance
 (SF1010 to Obtain Learner’s Permit)
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Email *
Requirements for Student
  • Must be 15 or older (or 1 week before 15th birthday)  
  • Pass more than half of your courses the previous grading period
  • Have fewer than 15 Unexcused Absences/Tardies during previous grading period OR fewer than 10 Consecutive Absences/Tardies during previous grading period
Certificate is valid for 30 days from the date it is signed. Certificates signed within the last 30 days of the school year are valid all summer.  If certificate expires and no permit is obtained you must complete another application or retain the original one and return it to the main office to be reissued.
Student Full Legal Name *
(First Middle Last)
Student Age *
Student Date of Birth *
MM
/
DD
/
YYYY
Student Race *
Last 4 digits of Social Security Number of Student *
Street Address *
City *
State *
Zip Code *
Phone Number with Area Code *
Parent Full Name  *
(First Middle Last)
 *this is the person accompanying the student to the test
Relationship to Student *
If student has had a previous Learner’s Permit or Driver’s License revoked or has a permit/license from another state, the following information must be provided. 
Driver License Number
State
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