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Fillable Printable Form DTP-422 - DMV's 30-Hour Basic Instructor's Course Notice - New York

Fillable Printable Form DTP-422 - DMV's 30-Hour Basic Instructor's Course Notice - New York

Form DTP-422 - DMV's 30-Hour Basic Instructor's Course Notice - New York

Form DTP-422 - DMV's 30-Hour Basic Instructor's Course Notice - New York

NOTICE OF ENROLLED, COMPLETED, AND DROPPED STUDENTS
OF DMV’S 30-HOUR BASIC INSTRUCTOR’S COURSE
DRIVER TRAINING PROGRAMS
DTP-422 (9/15)
Name of Enrolled Student
1.
2.
3.
4.
5.
Client ID #
Student’s Instructor
Certificate #
Date Student
COMPLETED
the Course
Date Student
DROPPED
the Course
COURSE SCHEDULE
Submit this form to DMV prior to the start date of the course, listing the names and client ID# of the enrollees. Then after the course is completed, complete the remaining
columns. (See form DTP-400 for more details on how to fill out this form.) Send form to New York State Department of Motor Vehicles, Bureau of Driver Training
Programs, 6 Empire State Plaza, Room 221, Albany, NY 12228.
Print Name of Owner or Corporate Officer
First Submission:
Date
Signature of Owner or Corporate Officer
I certify that all information and other matters contained herein are true in substance and in fact. Part 76.23(a)(5) of Commissioners Regulations authorizes
the Department of Motor Vehicles to suspend or revoke a driving school license for “the failure of the license for any partner, officer, agent or employee of the
licensee to conduct the prescribed tests for instructor applicants in the manner authorized by this department and/or the failure of the licensee or any partner,
officer, agent or employee of the licensee to conduct the 30-hour course to instructor applicants according to the curriculum supplied by this department
and/or for the number of hours required by this department and this part.”
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Print Name of Owner or Corporate Officer
FINAL Submission:
Date
Signature of Owner or Corporate Officer
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Driving School Offering Course: ______________________________________
Date of First Session: ____________________
AMENDED ON: __________________________________
Name of Instructor: __________________________________
¨
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