Student/NonAffliated Driver License Registration



1)Full Name - As It Appears on License                   

LAST                          FIRST                          Middle Name

2) Issuing State      

3) Date of Birth                                                                                        //

4) Drivers License Number      

5) Email         

I understand I am providing this information for use in connection with Arizona Administrative Code R2-10-207-12.  I hereby authorize Northern Arizona University, its agents and designers to use  that information to access and review my driving record.  By submitting this information, I represent it is true, and complete to the best of my knowledge.


FS - Transportation Service Center

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Northern Arizona University, South San Francisco Street, Flagstaff, Arizona 86011