- Form MV-278.5N - Roster and Control - New York
- Form MV-521.1 - Personal History - New York
- Form MV-278.8CDS - Pre-Licensing Course Completion Certificate Order Form - New York
- Form MV-279 - Request for Classroom Premises Check - New York
- Form MV-527 - List of Driving School Vehicles - New York
- Form MV-521 - Driving School License Application - New York
Fillable Printable Form MV-278.5N - Roster and Control - New York
Fillable Printable Form MV-278.5N - Roster and Control - New York
Form MV-278.5N - Roster and Control - New York
MV-278 ROSTER AND CONTROL
www.dmv.ny.gov
School Name
Date of Course
Address
Instructor’s Name (Print or Type)
Class Location
Instructor Card Number
INSTRUCTOR: u ONLY students who have a VALID LEARNER PERMIT are eligible to receive an MV-278 certificate upon completion of the course.
u If you are issuing a duplicate certificate, record the original MV-278 number, as well as the duplicate number.
u After issuing the MV-278 certificates at the end of a class session, enter the date and sign your name on the blank line below the last entry.
u Attach all voided certificates to the roster and return to DMV.
u When you request new books of MV-278 certificates, you must return the original Roster and Control sheets to your local Testing and Investigations Unit.
u Certificates must be listed in sequential order.
MV-278.5N (8/15)
PAGE 1 OF 2
Client ID
Number
Signature of Student For School Use
Name of Student
(Print or Type)
MV-278
Certificate
Number
Original
Certificate Number
(Duplicates Only)
Client ID
Number Signature of Student For School Use
Name of Student
(Print or Type)
MV-278
Certificate
Number
MV-278.5N (8/15)
PAGE 2 OF 2
Original
Certificate Number
(Duplicates Only)
