Driver's License Application

MIDDLEBURY COLLEGE
DEPARTMENT OF PUBLIC SAFETY
COLLEGE VEHICLE DRIVER'S
APPLICATION
APPLICANT INFORMATION

Name of Applicant:  __________________________ Date of Application:_______College I.D._______
(Please Print)
State of Residence:  __________________________   State License #:  ______________________

Department/Sponsor:    ________________________Date of Birth ___________________________
(Students must have Dept. or Organiation signature)