WYOMING RESTRICTED CLASS DRIVER LICENSE APPLICATION
Information & Instructions for Completion
INFORMATION:
When a restricted license is issued, it will expire thirty (30) days after the licensee’s sixteenth birthday.
The division may issue a restricted class "C" or "M" license, or both such licenses, to a person who is between the
ages of fourteen (14) and sixteen (16) years upon receipt of application, payment of the proper fees, an affidavit of
extreme inconvenience signed by the parent or guardian having custody of the applicant and a finding by the highway
patrol that extreme inconvenience actually exists.
An applicant for a restricted class “RC” license will be required to have an instruction permit prior to the issuance of the
restricted license. The applicant is required to hold the instruction permit for a minimum period of ten (10) days. The
applicant is required to present proof of identity, residency (may be in legal parent/guardian name) and social security
at the local driver license exam station for the issuance of the permit or restricted license. They must be accompanied
by their legal parent/guardian and will be required to pass the written and vision screening at the time of application for
the instruction permit. A skills test must be passed prior to issuance of the restricted license. The instruction permit
must be surrendered upon issuance of a restricted license.
INSTRUCTIONS: Please read the following instructions carefully!
Complete the required
application:
1. The affidavit must clearly indicate that the situation is one of extreme inconvenience
. Extreme
inconvenience includes the following circumstances (per W.S. 31-7-117c):
The person must drive to school and the person's residence is more than five (5) miles from the
school;
The person has a regular job (a minimum of 10 hours per week) more than five (5) miles from the
person's residence;
The person must have the license to work in his parent's business; or
Any other circumstance which the highway patrol finds is an extreme inconvenience. Administrative
Rules and Regulations of the Driver License Division limits this category to the need to provide
transportation for long-term medical treatment or conditions (not to include routine medical office
visits). Please contact the Highway Patrol for verification requirements for medical purposes.
2. The number of licensed drivers living in the same household must be listed, along with a clear explanation of
why these drivers are not able to provide transportation to the applicant.
3. The completed application must be signed, notarized, and mailed along with all appropriate verification
forms to: Wyoming Highway Patrol, Restricted License Investigations, 5300 Bishop Blvd, Cheyenne,
WY 82009-3340.
4. Restricted license approvals are only valid for 30 days
from issuance. If a restricted license is not obtained
in the 30 day approval timeframe and/or requires any changes, a new application must be submitted.
Complete all applicable
verification documents:
1. School Attendance Verification - Must be completed if the license is to be used for transportation to and
from the child’s school.
2. Work Verification - Must be completed if the license is to be used for transportation to and from the child’s
place of work.
3. Verification of Parental Ownership of Business - Must be completed if the license is to be used in
conjunction with the parental business.
4. Insurance Verification - Must be completed and submitted with the affidavit.
It may take up to six (6) weeks to receive a response (approval or denial) to your application. Incomplete,
inaccurate, or missing documents are grounds for denial of the application.
Note: A restricted class license and driving privilege will be suspended for: 1) a conviction of a moving
violation; 2) driving outside the approved hours of 5:00 am through 8:00 pm; 3) driving beyond the fifty (50) mile
radius of domicile; and/or 4) conviction of violating the restrictions of the license.
If you have any questions, please call 307-777-4314.
FSDL—708 INSTRUCTIONS (SEPT 24, 2018) WHP, Restricted License Investigations, 5300 Bishop Blvd, Cheyenne, WY 82009-3340
I hereby petition the State of Wyoming, Department of Transportation, for a Restricted Driver License for my minor child/ward listed above because of
the extreme inconvenience described above and I hereby certify under penalty of perjury that the above information is true and correct. In addition, I
certify under penalties of law, that I am the legal parent/guardian having custody of the minor child.
PARENT/GUARDIAN SIGNATURE DATE PRINT NAME FATHER MOTHER
LEGAL GUARDIAN
RESIDENTIAL ADDRESS (Where you currently live) CITY STATE ZIP CODE
CITY STATE ZIP CODE MAILING ADDRESS (if different from above)
You must complete all of the following:
1. Describe in detail the “extreme inconvenience”: (Attach additional pages as necessary)
2.
List the licensed drivers in your household, their employer, hours/days of employment, and explain in detail why each driver
cannot transport the minor child: (Attach additional pages as necessary)
3.
Is the license needed for school attendance or activities? ...................................................................................... ___YES ___NO
If yes, what hours will the minor child need to drive and what is the distance from home to school?
_______________________________________________________________________________________________________
4. Is the license needed for work purposes? ................................................................................................................ ___YES ___NO
If yes, what hours will the minor child need to drive and what is the distance from home to work?
_______________________________________________________________________________________________________
5. Is the license needed for work in parental business? .............................................................................................. ___YES ___NO
If yes, what hours will the minor child need to drive ? ____________________________________________
APPLICANT (MINOR CHILD) INFORMATION
DATE OF BIRTH
MONTH DAY YEAR
LEGAL LAST NAME
MIDDLE NAME, SUFFIX
FIRST NAME
HOME PHONE (including area code): PARENT EMAIL ADDRESS: WORK PHONE (including area code):
REVIEW
Approved _____________ Denied _____________
VERIFICATION DOCS
AFFIDAVIT SCHOOL WORK BUSINESS INSURANCE
COMMENTS
WHP REPRESENTATIVE SIGNATURE DATE
**WYOMING HIGHWAY PATROL USE ONLY**
WYOMING RESTRICTED CLASS DRIVER LICENSE APPLICATION
FSDL—708 APPLICATION (AUG 1, 2018)
This ________________________________________ signed and sworn to (or affirmed) before me on ____________________
Title of document being signed & sworn eg. application
by
Date
Name(s) or Person(s) Making Statement
(Seal)
Signature of Notarial Officer
My commission expires: _____________________________
Title (e.g. Notary Public) OR Rank (Rank if officer in active military)
State of _________________________________ County of _________________________________
WHP, Restricted License Investigations, 5300 Bishop Blvd, Cheyenne, WY 82009-3340
STUDENT NAME DATE OF BIRTH
SCHOOL NAME GRADE LEVEL
SCHOOL ADDRESS CITY STATE ZIP CODE
ACADEMIC STANDING
Complete all of the following:
1. Is the student academically eligible for activity? ....................................................................................................... ___YES ___NO
2. Is the student eligible for school provided transportation? ...................................................................................... ___YES ___NO
If no, please explain why or what are the circumstances: (Attach additional pages as necessary)
3.
Does the student attend the school for the area in which he/she resides? ........................................................... ___YES ___NO
If no, is it a parental or school decision? Please explain: (Attach additional pages as necessary)
Time classes begin ________________ Time classes end __________________
4. What is the school’s parking policy and does the student understand it?
5.
Is campus closed? ........................................................................................................................................................ ___YES ___NO
6. Has student attended driver’s education? ................................................................................................................. ___YES ___NO
Principal’s recommendation and comments:
If no, please explain _____________________________________________________________________________________
WYOMING HIGHWAY PATROL
RESTRICTED DRIVER’S LICENSE INVESTIGATION
SCHOOL ATTENDANCE VERIFICATION
FSDL—708 SCHOOL VERIFICATION (AUG 1, 2018)
This ________________________________________ signed and sworn to (or affirmed) before me on ____________________
Title of document being signed & sworn eg. school verification
by
Date
Name(s) or Person(s) Making Statement
(Seal)
Signature of Notarial Officer
My commission expires: _____________________________
Title (e.g. Notary Public) OR Rank (Rank if officer in active military)
State of _________________________________ County of _________________________________
INSTRUCTIONS: This form is to be completed by the Superintendent or Principal of the school attended by the student. All information
must be provided and the form must be notarized. Information supplied on this form will be used to determine the restrictions of the license.
(Incomplete or inaccurate information is grounds for denial). Attached additional sheets and verification as necessary
.
ACTIVITY DAY TIME BEGINS TIME ENDS TEACHER/ADVISOR
List all extra-curricular activities on the school premises: (Attach additional pages as necessary)
I certify that all information provided above is true and correct.
SCHOOL PRINCIPAL SIGNATURE DATE PRINT NAME
WHP, Restricted License Investigations, 5300 Bishop Blvd, Cheyenne, WY 82009-3340
EMPLOYEE/STUDENT INFORMATION:
NAME DATE OF BIRTH DATE OF EMPLOYMENT
BUSINESS INFORMATION:
LOCAL STREET ADDRESS CITY STATE ZIP CODE
TYPE OF BUSINESS CONTACT PHONE NUMBER
NAME OF BUSINESS (EMPLOYER)
Complete all of the following:
1. List the type of work performed by the employee (student):
2.
Will the employee (student) be operating a company vehicle? ............................................................................... ___YES ___NO
If yes, attach insurance verification form.
Employer’s recommendation and comments:
3.
Attach proof of regular employment (such as pay stub) and work schedule showing a minimum of ten (10)
hours per week.
Note: A restricted class license and driving privilege will be suspended for: 1) a conviction of a moving
violation; 2) driving outside the approved hours of 5:00 am through 8:00 pm; 3) driving beyond the fifty (50) mile
radius of domicile; and/or 4) conviction of violating the restrictions of the license.
WYOMING HIGHWAY PATROL
RESTRICTED DRIVER’S LICENSE INVESTIGATION
WORK VERIFICATION
FSDL—708 WORK VERIFICATION (AUG 1, 2018)
This ________________________________________ signed and sworn to (or affirmed) before me on ____________________
Title of document being signed & sworn eg. work verification
by
Date
Name(s) or Person(s) Making Statement
(Seal)
Signature of Notarial Officer
My commission expires: _____________________________
Title (e.g. Notary Public) OR Rank (Rank if officer in active military)
State of _________________________________ County of _________________________________
INSTRUCTIONS: This form is to be completed by the owner or person in charge of the business which employs
the student. All information must be provided and the form must be notarized. Information supplied on this form will be
used to determine the restrictions of the license. (Incomplete or inaccurate information is grounds for denial).
Attached additional sheets and verification as necessary
.
I certify that all information provided above is true and correct.
OWNER OR PERSON IN CHARGE OF THE BUSINESS SIGNATURE DATE PRINT NAME
WHP, Restricted License Investigations, 5300 Bishop Blvd, Cheyenne, WY 82009-3340
EMPLOYEE/CHILD INFORMATION:
DATE OF BIRTH
BUSINESS INFORMATION:
NAME OF BUSINESS
PRINCIPAL LOCATION OF BUSINESS CITY ZIP CODE
TYPE OF BUSINESS* *If agricultural, give location and description (Range and Township)
BUSINESS LICENSE NUMBER** ISSUED BY (CITY or TOWN)
SALES TAX LICENSE NUMBER** FEDERAL TAX ID NUMBER (to be provided in the event there is no business license)
NAME
**COPIES OF SALES TAX AND/OR BUSINESS LICENSES MUST BE ATTACHED to verify ownership of business
Provide explanation if no business, sales tax or federal tax ID number is available: ___N/A
List the type of work performed by your child:
List all employment*** of parents, if other than business (include name, address and phone number of employer):
***ATTACH COPIES OF PAY STUBS OR TAX FORMS (such as a schedule F or C) TO INDICATE REGULAR EMPLOYMENT
Note: A restricted class license and driving privilege will be suspended for: 1) a conviction of a moving
violation; 2) driving outside the approved hours of 5:00 am through 8:00 pm; 3) driving beyond the fifty (50) mile
radius of domicile; and/or 4) conviction of violating the restrictions of the license.
WYOMING HIGHWAY PATROL
RESTRICTED DRIVER’S LICENSE INVESTIGATION
VERIFICATION OF PARENTAL OWNERSHIP OF BUSINESS
FSDL—708 PARENTAL BUSINESS VERIFICATION (AUG 1, 2018)
This ________________________________________ signed and sworn to (or affirmed) before me on ____________________
Title of document being signed & sworn eg. Business verification
by
Date
Name(s) or Person(s) Making Statement
(Seal)
Signature of Notarial Officer
My commission expires: _____________________________
Title (e.g. Notary Public) OR Rank (Rank if officer in active military)
State of _________________________________ County of _________________________________
INSTRUCTIONS: This form is to be executed by parent who is the owner of the business which employs the student. All information
must be provided and the form must be notarized. Information supplied on this form will be used to determine the restrictions of the license.
(Incomplete or inaccurate information is grounds for denial). Attached additional sheets and verification as necessary
.
I certify that all information provided above is true and correct.
PARENT SIGNATURE DATE PRINT NAME
WHP, Restricted License Investigations, 5300 Bishop Blvd, Cheyenne, WY 82009-3340
CHILD INFORMATION:
CHILD’S NAME DATE OF BIRTH
WYOMING HIGHWAY PATROL
RESTRICTED DRIVER’S LICENSE INVESTIGATION
INSURANCE VERIFICATION
FSDL—708 INSURANCE VERIFICATION (AUG 1, 2018)
THIS DOCUMENT IS NOT PROOF OF INSURANCE AS REQUIRED BY W.S. 31-4-103(b)
MAKE ADDITIONAL COPIES AS NECESSARY
I verify that the parents, guardians or employer of the child named above have contacted this insurance company.
DATE AGENT SIGNATURE
INSURANCE COMPANY NAME CONTACT NUMBER
WHP, Restricted License Investigations, 5300 Bishop Blvd, Cheyenne, WY 82009-3340
The purpose of this form is to verify that the parents, guardians, or employer of the
child named above have contacted this insurance company to verify that the child is
eligible for coverage as a “restricted licensee” and not an “instructional licensee” (i.e.
the child will be driving alone without a licensed adult driver in the passenger seat of
the vehicle). This form is not intended as proof of insurance
, but rather to verify
the child is eligible for coverage if the license is issued and the applicant has been
made aware of any fees or increased premiums.
