The University of Alabama
Motor Vehicle Record (MVR) Release Form
Is driver high risk?
Driver's Full Name*
* As it appears on Driver's License
Driver's Date of Birth:
Type a date/Select a date
Driver's Email Address:
Driver's License Number (Not Tag Number):
State of Issuance:
* If licensed in the current state for less than 3 years, provide prior license number and state of issuance.
Please provide the approximate date and a brief description of any accidents where you were the driver of an involved vehicle and
another driver was determined to be at-fault
(e.g. rear-ended by other driver, other driver failed to yield, etc.) by the investigating law enforcement officer or the other party's insurance carrier accepted responsibility for the damage and/or injuries:
Type a description
By checking this box, I indicate my understanding of the information shown on this form, and it is my intent to sign the record. I certify that I am the individual stated and my answers are complete and correct.
Campus - P.O. Box:
Manager/Supervisor/Contact Email Address:
All new drivers view the driver safety video program on the Risk Management website as soon as possible after being authorized to operate a University vehicle.
Any driver that may operate a van with a capacity of 9 or more (including driver) must take an online safety training course. Contact
to obtain the online access information.
Type a comment
No items to display.