Driver Authorization Form

Under the university's Vehicle Use Policy, you are required to complete a driver authorization form prior to driving (1) a university vehicle OR (2) a personally-owned vehicle on an officially recognized Sport Club trip where you will be driving another student or seeking reimbursement.
* Required










Driving Information

The following questions ask for information that you are obligated to update. If there is any change to any of the answers you provide below, you are required to notify the sport club coordinator promptly before driving to/from any recognized sport club events / practices. This means that you must tell us before driving a university van or taking another student(s) in your car for sport club travel if, for example: *you get a speeding ticket, *have an accident, *your license expires, *your inspection sticker expires *any other relevant driving history changes







Moving Violation Record

If you have had a moving violation in the past 5 years, indicate the date* and briefly describe the nature of each violation (for example, whether it was a speeding ticket, reckless driving, etc). If, as a result of vehicle-related convictions, you are currently in a special-risk, high-risk, or assigned-risk insurance pool, note that in your answer. *Dates can be approximate, particularly for older incidents. For example, "January 2009" or "fall 2004" are acceptable.



Vehicle Accident Record

If you have been involved in an accident, indicate the date(s) and briefly describe the nature of the accident below. If the accident was minor (such as a fender-bender or other low-speed, low-damage incident), no further information is needed. For more significant accidents: (1) Give information relevant to the cause, such as whether you rear-ended another vehicle, were hit by a drunken driver, ran into an obstacle in the road, lost control while speeding, etc. (2)Unless another driver was clearly at fault, indicate if serious injuries resulted.



DUI or DWI Record




License Suspension

Suspensions for reasons unrelated to driving, driver safety, alcohol, or drugs do not need to be reported. Suspensions for failure to pay court fines or child support are examples of reasons that do not need to be reported. Failure to pass a mental or physical exam, or to stop at the scene of an accident, are examples of driving-related reasons that do need to be reported. Provide the dates of the supsension, the reason for the suspension, and any other information you think relevant.



Acknowledgment

By providing my e-signature below, I certify the accuracy of the information I have provided, and that I have read and agree to comply with the Vehicle Use Policy, including the driver conduct regulations. I also understand that I have an opportunity to complete and submit this Form in paper format by downloading the PDF version, but do freely choose to submit the online version, using my Student B# as my electronic signature.




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