New York State Department of Motor Vehicles
VEHICLE ESCORT DRIVER APPLICATION
Note: To become a certified vehicle escort driver, you MUST:
l Have a valid driver license l Pay a $40 fee l Present proof of ID
l Be at least 21 years old l Pass a written exam (as listed on ID-44)
Note: If you are a New York licensed driver and need to change your name and/or address, you must notify DMV of any
change BEFORE you submit this application to the Bus Driver Unit.
If you are applying for a replacement or need to change your name and/or address on your certificate, complete this form
and mail it to: NYS Department of Motor Vehicles, Bus Driver Unit, 6 Empire State Plaza, Room 136B, Albany,
New York 12228. A $5.00 check (payable to the Commissioner of Motor Vehicles) is required for a replacement certificate.
If you are applying for a renewal, complete this form and mail it to: Department of Motor Vehicles, 207 Genesee Street,
Utica, NY 13501-2874. A $40 check (payable to Commissioner of Motor Vehicles) is required for a renewal.
Month Day Year
o Original Certification o Renewal o Replace Certificate o Amend Certification
Name of Applicant (Last, First, Middle)
Phone Number (Include area code)
Date of Birth
Client ID number as it appears on your
NYS Vehicle Escort card (if available)
driver license Driver License Number
Address Where You Get Your Mail (Include Street Number and Name, Rural Delivery, and/or Box) Apt. #
City or Town State Zip Code County
Address Where You Live - If different from your mailing address
(Include Street Number and Name, Rural Delivery, and/or Box) Apt. #
City or Town State
Print your former name exactly as it appears on your escort certificate
Zip Code County
Other Change: What is the change and the reason for it ( wrong date of birth, etc.)?
DMV USE ONLY
o Driver License/ID
Address Change for: o Mailing Address o Legal Address
Does any of the information
on your Escort Certificate
have to be changed?
o Yes o No
I state that the information I have given on this application is true to the best of my knowledge. I certify that I am the holder of a valid driver
license that is not now suspended or revoked, and that I have not lost my privilege to drive in New York State.
(Sign name in full - A married woman must use her own first name.)
PLEASE PRINT WITH BLUE OR BLACK INK IN THE BOXES