DC DRIVER LICENSE or IDENTIFICATION CARD
APPLICATION
The information you provide will be used to register you to vote or update your registration unless you decline in Section G.
A. What do you need?
Driver License Identification Card Motorcycle Endorsement
B. Tell us about yourself
Last Name
First Name
Middle Name
Jr./Sr./III, etc.
Address where you live
(a mailing only address cannot be used)
Apt/Unit #
City & State
ZIP Code
Washington, DC
Date of Birth
Social Security #
U.S. Citizen
Gender
/
/
Yes
No Male Female
Unspecified
Weight
Height
Hair Color
Eye Color
Other names you have used on a Driver License or ID Card.
LBS
FT IN
Cell Phone
Alternate Phone
Text Notification
Email
( )
( )
Yes Standard rates apply
C. Tell us about your driving history
1. Have you ever had a Driver License? If yes, write from what country, state, or jurisdiction?
Yes
No
2. Has your license ever been suspended or revoked?
Yes
No
3. Has your application for a Driver License been denied in another country or state?
Yes
No
D. Tell us about your medical history Skip this section if you are only here for an ID card.
1. Do you require corrective lenses or glasses for the vision screening test?
Yes
No
2. Are you required to wear a hearing device while driving?
Yes
No
In the past 5 years, have you had or been treated for any of the following? If yes, to an item, please complete the Medical/Eye form.
1. Alzheimer’s Disease
Yes
No
2. Insulin Dependent Diabetes
Yes
No
3. Glaucoma, Cataracts, or Eye Diseases
Yes
No
4. Seizure or Loss of Consciousness
Yes
No
5. Do you have other mental or physical conditions that would impair your ability to drive?
Yes
No
E. Tell us about your preferences
1. All males 18-26 years old will be registered with Selective Service. To opt out, complete the opt-out form
2. I would like to add a Veteran designation to my license/ID card.
Yes
If yes, provide proof of your status
3. I would like to be an organ and tissue donor.
Yes
4. What language should we use to communicate with you?
_
____________________________________________________
Special Designations (Optional):
Add to my Driver License or ID Card
Autism
Intellectual Disability
Visually Impaired
Hearing Impaired
Office Use:
F. If you are 70+ years of age, your licensed medical practitioner MUST complete this section
Practitioner’s Name (print)
Practitioner’s Identification Number
Phone Number
Does the applicant have the ability to safely drive a vehicle?
Yes, the applicant can safely drive a vehicle.
No, the applicant cannot safely drive a vehicle.
Practitioner’s Signature:
Date:
To confidentially report waste, fraud or abuse by a DC
Government Agency or official, call the DC Inspector
General at 1.800.521.1639
Office Use: Form revised October 2021
Employee Signature: Date:
Questions: Please visit our website at dmv.dc.gov or call 311 in DC or 202.737.4404 outside the 202 area code.
Continued on Next Page →
G. Voter Registration
Unless you decline, the information you have provided on this application will be used to register you to vote or
update your registration. If you do not meet the voter registration requirements listed below, or if you do not want to
register to vote, you MUST decline.
To register to vote, you must:
• Be a U. S. Citizen
• Live in the District of Columbia. (You may not vote in an election in the District of Columbia unless you have lived
in the District of Columbia for at least 30 days before the election in which you intend to vote.)
• Not claim voting residence outside of the District of Columbia
• Be at least 16 years old. (You may pre-register at 16. You may vote in a primary election if you are at least 17
years old and you will be 18 years old by the next general election. You may vote in a general or special
election if you are at least 18 years old.)
• Not have been found by a court to be legally incompetent to vote
□ I decline. Do not register me to vote or update my voter registration.
(If you decline, skip to Section H, Applicant Certification)
Party Registration. To vote in a primary election in the District of Columbia, you must be registered to vote in one of the
following four (4) parties (Check ONE box below):
□
Democratic Party
□
D.C. Statehood Green Party
□
Republican Party
□
Libertarian Party
If you register as “No Party (independent)” or with another party not listed above, you may not vote in primary
elections.
If you do not choose a party, you will be registered as “No Party (independent).”
□
No Party (independent)
□
Other (write party name here) ___________________________________________
If you need help with voting, please tell us what type of help you need (optional):
Address where you get your mail (if different from above):
Name and address on your last voter registration (include city and state if outside of D.C.):
Would you like information on serving as a poll worker in the next election?
□ Yes □ No
Important Notices. Voter registration information is public, with the exception of full/partial social security numbers,
voter registration numbers, dates of birth, email addresses, and phone numbers. If you decline to register to vote, your
decision will be confidential. If you choose to register to vote, the agency at which your voter registration application
is submitted will remain confidential and will be used only for your voter registration purposes.
In order for your residence and/or mailing address to be kept confidential, you must submit to the Board of Elections’
Registrar of Voters a court order directing that such information must be kept confidential.
If you believe that someone has interfered with your right: a) to register to vote; b) to decline to register to vote; c) to
privacy in deciding whether to register or in applying to register to vote; or d) to choose your own political party or
other political preference, you may file a complaint with the Executive Director of the Board of Elections, 1015 Half
Street, SE, Suite 750, Washington, DC 20003.
If you do not receive a voter registration card within three weeks of completing this application, call the Board of
Elections at 202-727-2525. You may also visit the Board of Elections’ website at www.dcboe.org.
For TTY assistance, call
711. Si necesita esta informacion en español, llame al 202-727-2525.
H. Applicant Certification
I hereby certify, under penalty of perjury, that the information contained on this application is true and correct. If I am
applying to register to vote, I swear or affirm that I meet each requirement listed in Section G. I understand that: a) any
person using a fictitious name or address and/or knowingly making any false statement on this application is in violation
of DC Law and subject to a fine of up to $1,000 and/or up to180 days imprisonment (DC Official Code 22-2405), and; b)
any person who registers to vote or attempts to register and makes any false representations as to their qualifications
for registering is in violation of DC Law and subject to a fine of up to $10,000 and/or up to 5 years imprisonment (DC
Official Code 1-1001.14(a)).
Applicant Signature: Date: _______________________
