Please fill out the following form to request that someone contact you to set up a road test appointment. You will need to have read and understood the Michigan Road Skills Test Study Guide (available in PDF format here). Before your road test, please make sure the vehicle you will be using has enough fuel for a minimum of 25 miles of driving. A parent or guardian must accompany you on the road test.

About You...
First Name:
Last Name:
Date of Birth:	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Before 1980 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
Age:
Telephone:
About Your Parent or Guardian...
Parent/Guardian's Name:
Parent/Guardian's Cell #:
Parent/Guardian's Work #:
About Your Driver's License and Level 1 (L1) Learner's License...
Driver's License Number:
L1 License Issue Date: This will be found on the top center of the permit. It starts with a zero (0) or one (1) and you will only need the first 8 digits.
L1 License Expiration Date:

Other Information...
I have a Segment II Completion Certificate:	Yes No
I have tested elsewhere in the past 24 hours:	Yes No
I have experience in a variety of traffic situations: (including city, residential, expressway)	Yes No
I have a valid Social Security card:	Yes No
By clicking the "submit" button below, you agree that all the information given above is correct to the best of your knowledge. You also agree that you are aware of the information presented on our fees and other policies page.
·