DRIVER TRAINING SCHOOL CHECKLIST
MV3757 Wisconsin Department of Transportation 1/2007 s.343.60-.72 Wis. Stats., Trans. 105 Wis. Adm. Code
This checklist includes the minimum requirements. Prior to submitting application: School Name has been approved Home Office only DOT On-site Visit
A. Forms and Fees
Form M3110 Driver School Application + $190.00* (2 yrs.) Form MV3684 Classroom Certification Form MV3112 Driver Instructor Application + $50.00* (2 yrs.) Bond Form MV3264 Vehicle Record Business Liability Insurance Form MV3683 Office Certification Vehicle Insurance * Actual fees for Driver School or Instructor license may vary based on the established expiration date.
B. Student Record
Contract/ Agreement # Cooperative Driver Testing Program Scores (CDTP optional) Fees Charged Instructor's License Number Instructor's Name Lesson Dates Lesson Duration Student's Birth Date Student's Home Address Student's Name Last, First, Middle Total Number of Instruction Hours Type of Lessons / Services Vehicle ID (VIN)
Address of Student/Customer Signature of Customer Agreement Date Signature of Parent/Guardian if student is under 18 Consecutively Numbered Signature of School Representative Fee Charged "This constitutes..." Statement * School Name Types of Lessons / Services * This constitutes the entire agreement between the school and the student and no verbal statement or promises will be recognized. REFUND verbiage (if added): This school will not refund any tuition or part of tuition if the school is ready, willing and able to fulfill its part of the agreement.
D. Fee Schedule
A list which shows the maximum fees that will be charged for each of the services listed on the Contract / Agreement.
E. Course Summary/Outline (Suggested 2 pages per lesson type: Classroom, B-T-W, 40 hr. Instructor, 10 hr. Refresher)
Send only the Course Summary to the DOT with the Driver Training School Application and keep the lesson plans on file at the school office. Each summary shall specify a minimum of one main topic or more for each hour of instruction. To be approved, all required topics as indicated below must be included in the summary for classroom and / or B-T-W.
F. Lesson Plans - The plan for each lesson or session must include:
Objectives Reference Materials Time Allotted Title of Lesson / Session # Training Aides Type of Lesson - Lecture, video etc.
1. Classroom - All of the following topics are required for the classroom course Awareness of Motorcycles, Bicycles, Pedestrians Predriving Skills / Maneuvers City Driving Psychophysical Aspect - Alcohol, mood, health etc. Environmental Dynamics Responsibility of Vehicle Operation Freeway Driving Rural Driving Hazards Farm Animals, Machinery Traffic Citizenship and Highway Safety Progress Hazards Railroad Crossings Vehicle Mechanical / Control Features Organ and Tissue Donation (30 min.) Vehicle Ownership Responsibilities 2. Behind-the-Wheel - All of the following topics are required for B-T-W training course. Backing and Y-turns Introduction to the Automobile City Driving Left and Right Turns Hazards Farm Animals, Machinery Parking Hazards Railroad Crossings Rural Driving - Include multiple lanes, freeway Submit documentation with this checklist to: Wisconsin Department of Transportation, DMV PO Box 7920 Madison, WI 53707-7920 OR FAX to: 608-261-8201 If you have questions, please E-mail: [email protected] OR Telephone: 608-264-7049