DL-14B Applicant Form

Minor form. Save draft any time. Use “Save + Print” when you want the filled PDF generated for signature and printing.

Top Application Section

This portion is locked for your workflow: Driver License, Class C, and Modify.

Applicant Information
Contact Information
Emergency Contacts

In the event of injury or death, you may provide up to two emergency contacts.

Required Information From All Applicants
Physician must complete form DL-101.
Yes = Add/Keep my name on the Donate Life Texas Registry (Add/Keep Hero’s Heart Symbol).
No = Does not add your name to the Registry and does not remove your name if already registered.
By selecting no, you must remove your name from the Donate Life Texas registry separately.
If yes, please indicate a donation amount of $1 or more.
If yes, please indicate a donation amount of $1 or more.
If yes, please indicate a donation amount of $1 or more.
If yes, please indicate a donation amount of $1 or more.
If yes, please indicate a donation amount of $1 or more.
If yes, please indicate a donation amount of $1 or more.
Medical History Questions
Examples, including but not limited to: diagnosis or treatment for heart trouble, stroke, hemorrhage or clots, high blood pressure, emphysema (within the past two years), progressive eye disorder or injury (i.e., glaucoma, macular degeneration, etc.), loss of normal use of hand, arm, foot or leg, blackouts, seizures, loss of consciousness or body control (within the past two years), difficulty turning head from side to side, loss of muscular control, stiff joints or neck, inadequate hand/eye coordination, medical condition that affects your judgment, dizziness or balance problems, or missing limbs.
Driver History Information
Vehicle Registration and Insurance Information
Texas Transportation Code section 502.040.
Texas Transportation Code section 601.051.
Certification
I do solemnly swear, affirm, or certify that I am the person named herein and that the statements on this application are true and correct. I further certify my residence address is a (select one): single family dwelling, apartment, motel, or temporary shelter. I agree to immediately report to the Texas Department of Public Safety any changes in my medical condition which may affect my ability to safely operate a motor vehicle. I further understand that I am required by law to report any change of name or address to the Department of Public Safety within thirty days.
Use the date the applicant signs the printed form.
Minor Receipt Acknowledgment
Texas law requires the Texas Department of Public Safety to provide every minor applicant (under age 18) and cosigner, for a driver license in Texas, educational information concerning state laws relating to distracted driving, driving while intoxicated, driving by a minor with alcohol in the minor’s system, and the implied consent law. The minor applicant and cosigner must acknowledge receipt of this information prior to issuance of any driver license or permit.
Minor applicant and parent/legal guardian signatures should still be handwritten on the printed form.
Parental Authorization
I do solemnly swear, affirm, or certify that I am the person named herein, that the statements on this application are true and correct, that the above named applicant is my child, stepchild, or ward, and that I have legal custody of the applicant. I authorize the Department of Public Safety to issue a Class C license to said minor. The Department can access the said minor’s school enrollment from the Texas Education Agency, and a school administrator or law enforcement officer is authorized to notify the Department if the said minor is absent for at least 20 consecutive instructional days. This parental authorization applies to all renewal and replacement driver license transactions until the minor’s 18th birthday, unless rescinded.