Statement of Agreement Form

Driver Certification Statement of Agreement Form

In order to determine your insurability and certification, the University of Dayton requires your consent to review your motor vehicle record in order to ascertain if you have received any violations, accidents or notices of high-risk driving.  Please enter your contact, affiliation and driver license information in order to gain approval to drive University of Dayton vehicles.  When choosing a department or organization, please select the one that best fits from the drop down menu (see department and organization sheet if you need help determining this).  If your department or organization is not listed, choose other. 

Contact Information


* Affiliation (check one)

Driving For Information


Driver's License and Driver Status Information


* Is it in Your Job Description to Drive Regularly (check one)
* Have You Been Personally Assigned a UD Vehicle Exclusively for Your Use? (check one)

Permission and Electronic Sign-off


* I give my permission for the University of Dayton to check my driver's license status, as needed, with the Bureau of Motor Vehicles
* I have read and understand the Vehicle Use and Driver Training Policy (included as part of the Driver Certification session)
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