Enrollment - Exclusion DL-93 Application pdf Alabama

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ALABAMA LAW ENF ORCEMENT AGENCY ENROLLMENT / EXCLUSION FORM To Implement Sections 16 -28- 40 through 16 -28- 45, Code of Alabama, 1975 Follow instructions on the back of this form. Print or type all information. I. APPLICANT* Driver's License No.: Social Security No.: Sex: Male/Female Legal Name: Date of Birth: Last First Mi MM/DD/YY Address: Street City State Zip II . ENROLLMENT* SCHOOL OR GED OR JOB TRAINING PROGRAM Name: Check one: GED Program (School , GED , or Job Training Program) Address: Job Training Program Secondary School Street City State Zip Signature: Title: Telephone No.: Total Number of Disciplinary Points imposed in school for di sciplinary a ction ____________ Enter t he ac tual date of c ompliance or no ncompliance i n the bl ank l ocated to the l e ft of t he appr opriate statement. IN COMPLIANC E NOT IN COMPLIANCE The applicant: The applicant: Is enrolled. Date Is not enrolled. Date Withdrew due to circumstances beyond Has accumulated more than 10 consecutive Date his or her control.* Date or 15 cumulative unexcused absences during a single semester. Has obtained a GED Certificate. (Only for students enrolled in secondary school) Date Is not maki ng satisfactory progress. Date (Only for GED students) III . EXCLUSION Enter t h e actual d ate in t he blank l ocated t o t he left o f t he appropriate statement. The a pplican t: Is a parent w ith the care and custody of a minor Date or unborn child. Physician/Hea lt h Department Is the sole source of transportation for the parent(s). Date Street City State Zip Phone Physician's Signature Enter the beginning date of employment. The applicant: Place of Emplo yment Is gainfully and substantially employed. Date Street City State Zip Phone *Defined on the back of this form. Revise d 0 4 /20 22 Employers Signature _______________________________________________ The applicant was previously reported as Date being noncompliant. As of this date, the student has complied. Check if this student classified as a " qualified student " Defined P er Act 2022-300 SCHOOL OFFICIAL APPLICANT PHYSICIAN/HEALTH OFFICIAL EMPLOYER LEGISLATIVE AUTHORITY ''The Department of Public Safety shall deny a driver's license or a learner's license for the operation of a motor vehicle to any person under t he age of 1 9 who d oes not, at t he time of ap plication, present a diploma or o ther cer tificate of graduation i ssued t o the p erson from a secondary high school of this state, or any other state, or docu mentation that the person: (1) is enrolled and making satisfactory progress in a course leading to a general educational development certificate (GED) from a state app roved institution or org anization, or has obtained the certificate; (2) is enrolled in a secondary school of this state or any oth er state; (3) is participating in a job training program ap proved by the State Superintendent of Education ; (4) is g ainfully and substantially employed; (5) is a parent with the care and custody of a minor or unborn child; (6) has a physician certify that the parents of the p erson depend on him or her as their sole source of transp ortation; or (7) is exempted from this requirement due to circumstances beyond his or her control as provided in this chapter.'' Ala. Code §16-28-40 (19 75) . Act 2022-300 provides the term "qualified student" refers to a student meeting the definition of a "homeless child or youth" as provided by 42 U.S.C. § 11434(a)(2). GENERAL INFORMATION/INSTRUCTIONS 1. Individuals under the age of 19 applying for, renewing, or seeking reinstatement of a driver's license or learner's permit to operate a motor vehicle must present to the area driver's license examiner a diploma or other certificate of graduation, a GED Certificate, or an Enrollment/Exclusion Form. 2. Print or type all information. 3. Part I must be completed for all reports. Note: The driver's license number may not be available. This is th e only information in Part I which may be left blank. 4. The atten dance officer or chief attendance administrator, upo n request, shall prov ide d ocumentation of enrollmen t status (complete Part I and Part II ) for any student 15 years of age or older who is properly enrolled in a school under the jurisdiction of the official. The applicant should submit this form to the area Driver's License Examiner. 5. Whenever a student 16 years of age or older withdraws from schoo l without meeting the exclusion ary conditions of this legislation, th e attendance officer or chief attendance ad ministrator shou ld complete Part I and Part II of this form an d submit to the Department of Public Safety, Driver Improvement, P. O . Bo x 14 71, Montgomery, Alabama 36102-1 471. No oth er report shoul d be s ubmitted un less t he i ndividua l c hanges c ategories f rom non compliance t o compliance. 6. Appeals relative to secondary school enrollment status should be filed with the local school principal in accordance with local board of education policies. 7. Exclusion status for individuals claiming an exemption from this legislation shou ld be completed by the health official as identified in Part III of this form. The applicant is responsible for securing proper documentation for presentation to the Department of Pu blic Safety. DEFINITIONS 1. Applicant- An individual between the ages of 15 and 19 applying for, renewing, or seeking reinstatement of a driver's license or a learner's permit for the operation of a motor vehicle. 2. Circumsta nces beyo nd the control of applicant- Valid reasons for exemp tion from th is legislation: a. Students who are mentally or physically unable to attend school b. Students who are regularly and legally employed un der the provisions of the Child Labor Law c. Students who, because of the distance they reside from school and the lack of public transportation, are compelled to walk more than two miles to attend a public school (Does not inclu de suspen sion o r expulsio n from school o r impriso nment.) 3. Enrollment- The status of an individual who is: a. Enrolled in a school; b. Enrolled in a GED program; or c. Enrolled in a job training pro gram approved by the County Superintendent of Education.

DL-93 PDF

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