Form MV-278.5N - Roster and Control - New York
MV-278 ROSTER AND CONTROL
Date of Course
Instructor’s Name (Print or Type)
Instructor Card Number
INSTRUCTOR: u ONLY students who have a VALID LEARNER PERMIT are eligible to receive an MV-278 certificate upon completion of the course.
u If you are issuing a duplicate certificate, record the original MV-278 number, as well as the duplicate number.
u After issuing the MV-278 certificates at the end of a class session, enter the date and sign your name on the blank line below the last entry.
u Attach all voided certificates to the roster and return to DMV.
u When you request new books of MV-278 certificates, you must return the original Roster and Control sheets to your local Testing and Investigations Unit.
u Certificates must be listed in sequential order.
PAGE 1 OF 2
Signature of Student For School Use
Name of Student
(Print or Type)
Form MV-278.5N - Roster and Control - New York PDF
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