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SECTION A APPLICANT INFORMATION Check one box. A separate OL 766 is required for each type of program submitted for authorization. Classroom Home Study IF LESSON PLAN IS A FOREIGN LANGUAGE PLEASE CHECK OTHER BOX AND INDICATE THE LANGUAGE Internet English Other TRUE FULL NAME LAST FIRST MIDDLE MAILING ADDRESS CITY STATE ZIP CODE AREA CODE / TELEPHONE NUMBER TVS SCHOOL NAME TVS NUMBER IF APPLICABLE SECTION B PROGRAM/OWNER INFORMATION PROGRAM OWNER S NAME LAST FIRST MIDDLE LESSON PLAN CONTROL NUMBER SECTION C REQUIREMENTS TVS educational programs have to be reviewed and approved by the department or agent of the department every year. If this TVS educational program has not been approved in the past 12 months the program owner must resubmit it for approval. The date of approval may be determined from the Request for Approval of TVS Educational Program OL 764 which was returned to the program owner upon approval. Authorization for use of this purchased TVS educational program may be postponed until the Traffic Violator School is ready to instruct students. STATE OF CALIFORNIA DMV USE ONLY RECEIVED DATE ISSUED BY AMOUNT PAID DEPARTMENT OF MOTOR VEHICLES CHECK / M. O. NUMBER A Public Service Agency REQUEST FOR USE OF AN APPROVED TVS PROGRAM Instructions Print clearly in blue or black ink or type. Mail completed and signed form along with the letter of authorization from the program owner and 25. 00 fee to Department of Motor Vehicles Occupational Licensing Branch P. O. Box 932342 MS L224 Sacramento CA 94232-3420. SECTION A APPLICANT INFORMATION Check one box. A separate OL 766 is required for each type of program submitted for authorization* Classroom Home Study IF LESSON PLAN IS A FOREIGN LANGUAGE PLEASE CHECK OTHER BOX AND INDICATE THE LANGUAGE Internet English Other TRUE FULL NAME LAST FIRST MIDDLE MAILING ADDRESS CITY STATE ZIP CODE AREA CODE / TELEPHONE NUMBER TVS SCHOOL NAME TVS NUMBER IF APPLICABLE SECTION B PROGRAM/OWNER INFORMATION PROGRAM OWNER S NAME LAST FIRST MIDDLE LESSON PLAN CONTROL NUMBER SECTION C REQUIREMENTS TVS educational programs have to be reviewed and approved by the department or agent of the department every year. If this TVS educational program has not been approved in the past 12 months the program owner must resubmit it for approval* The date of approval may be determined from the Request for Approval of TVS Educational Program OL 764 which was returned to the program owner upon approval* Authorization for use of this purchased TVS educational program may be postponed until the Traffic Violator School is ready to instruct students. Pursuant to California Code of Regulations CCR Section 345. 32 a 1 C the program owner is responsible for updating their your own TVS educational program or purchase an existing approved TVS educational program from another program provider. I certify or declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. I further certify that the named owner has given me permission to use the TVS education program they have had approved within the past 12 months and that I have read the Requirements section of this form* SIGNATURE PRINTED NAME DATE X FOR OFFICIAL DMV OR CONTRACT AGENT USE ONLY First Rejection Final Rejection Approved OL 766 REV..

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