Driver Record Request

I authorize Eastern Oregon University to receive a copy of my driving record
from the Motor Vehicle Department.

First Name:

As it appears on your Driver's License.

M.I.:

Last Name:

Date of Birth:

Driver License Number:

State of Issue:

Signature:

Department Supervisor Name:

Supervisor Email:

Department Requesting Record:

Index/Account Number to be charged:

**It takes at least 10 working days to receive records from Oregon's DMV.
Other states can take up to six to eight weeks.