LifeWise Vehicle Driver Screening

This form should be used ONLY by drivers who will be borrowing a LifeWise vehicle, not by drivers who will be transporting LifeWise students. Any driver who will be transporting LifeWise students must apply as a LifeWise driver and complete a background check and necessary training.

Driver Information

First Name

Last Name

Date of Birth

##/##/####

LifeWise Program from which the Vehicle will be Borrowed

Driver's License State

Driver's License Number

Driver's License Expiration Date

Driver's License Type

Program ID