Get Mi Des-n05 2019-2025

Filling out the MI DES-N05 form is an essential procedure for individuals applying for a driver education instructor or driving skills examiner certification in Michigan. This guide provides a clear and detailed approach to successfully completing the form online.

Follow the steps to complete the MI DES-N05 form online.

1. Click ‘Get Form’ button to access the form in the digital format for your completion.
2. In Part A – Release of Information, specify your application type by selecting either 'Driver Education Instructor' or 'Driving Skills Examiner' and provide your instructor’s certificate number if applicable. Fill in your name (last, first, middle), street address, city, state, date of birth, and zip code.
3. Authorize the release of your medical information by signing and dating the signature field. Be sure that your signature matches your name on the application.
4. For Part B – Health Questions, ensure that a physician completes this section. You will need to answer questions regarding your ability to recognize traffic signals, visual acuity, cardiovascular health, respiratory conditions, and any other impairments. Make sure your physician verifies and provides detailed answers.
5. In Part C – Medical Examiner’s Certification, your physician will certify their findings based on your health examination. This section includes ticking the appropriate boxes regarding your physical condition and capabilities.
6. Finally, your physician should complete their name, office phone number, office address, license number, and signature, along with the date the medical examination report was completed.
7. Once the form is completed, ensure that you save any changes made, and download or print the form as necessary for submission or future reference.

Complete the MI DES-N05 form online today for a smooth application process.