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Blank Texas From Dl 77 Form

The Texas DL-77 form is an application for a Hardship Driver License, designed for individuals facing unique challenges that hinder their ability to obtain a standard driver’s license. This form allows applicants to demonstrate their need for a license due to economic hardship, family illness, or enrollment in vocational education programs. Understanding the requirements and process for this application is essential for those who qualify and seek to navigate their circumstances effectively.

Outline

The Texas DL-77 form is a crucial document for individuals seeking a hardship driver license in the state of Texas. This application is designed for those who may face unusual economic hardship, need to care for a sick family member, or require a license to participate in a vocational education program. To apply, individuals must fill out the form completely in ink, providing personal information such as name, date of birth, and contact details. The form also requires applicants to disclose their medical history and any conditions that might affect their ability to drive safely. Furthermore, the application includes sections for emergency contacts, vehicle registration, and insurance information. It is important to note that once submitted, the Texas Department of Public Safety does not refund payments, and applications are held for a maximum of 90 days. The form also allows for optional donations to various causes, including support for organ donation and assistance for survivors of sexual assault. Understanding the requirements and implications of the DL-77 form is essential for applicants as they navigate the process of obtaining a hardship driver license.

Sample - Texas From Dl 77 Form

DL-77 - TEXAS HARDSHIP DRIVER LICENSE CARD APPLICATION

NOTICE: All information on this application must be in INK. Applications held for 90 days only.

DPS CANNOT REFUND PAYMENT ONCE APPLICATION IS SUBMITTED.

FOR DEPARTMENT USE ONLY

Class (select one):____C ____M

ASSIGNED # _______________________

The Texas Department of Public Safety may issue a driver license to a person who complies with the requirements for the Hardship License if (1) the failure or refusal to issue the license will result in an unusual economic hardship for the family of the applicant, (2) the license is necessary because of the illness of a member of the applicant’s family, or (3) a license is necessary because the applicant is enrolled in a vocational education program and requires a driver’s license to participate in the program. The completion of an approved course in driver education is required. Texas Transportation Code 521.223 and 521.224

APPLICANT INFORMATION

Last Name:_________________________________________ First Name:_________________________________________ Middle Name: ___________________________

Suffix:__________________________________ Birth Surname

( Maiden):_________________________________________

SSN:________________________________

Date of Birth (mm/dd/yyyy):_____________________

Sex (select one): ___ Male

___ Female

Height: ______ Ft.

______ In.

Weight: __________ Lbs.

Eye Color (select one): ____ Blue

____ Brown

____ Gray

____ Hazel

____ Green

____ Black

____ Maroon

____ Pink

Hair Color (select one):

____ Black

____ Red

____ Gray

____ Brown

____ Blonde

____ Bald

____ White

Race (select one): ____ (AI) Alaskan or American Indian

____ (AP) Asian or Pacific Islander

____ (BK) Black

____ (W) White

Ethnicity (select one):

____ (H) Hispanic Origin

____ (O) Not of Hispanic Origin ____ (U) Unknown

Place of birth: City:_______________________________________

State: _____

County:________________________ Country: ___________________________________________

Father’s Last Name:_________________________________________________________

Mother’s Maiden Name: ____________________________________________

CONTACT INFORMATION

Residence Address:_______________________________________________________________________________________________________________________

City:_______________________________________________________ State: _______ Zip Code:____________ County: _______________________________________

Mailing Address: __________________________________________________________________________________________________________________________

City:_______________________________________________________ State: _______ Zip Code:____________ County: _______________________________________

Home Phone:________________________ Other Phone:________________________ Email: _____________________________________________________________

In the event of injury or death would you like to provide up to two (2) emergency contacts? If yes, please list:

a)Name ____________________________________ Phone Number __________________ Address _________________________________________________________

b)Name ____________________________________ Phone Number __________________ Address _________________________________________________________

REQUIRED INFORMATION FROM ALL APPLICANTS

YES NO

1.	___	___	Are you a citizen of the United States?
2.	___	___	Do you have a health condition that may impede communication with a peace officer? (physician must complete form DL-101).
3.	___	___	Would you like to register as an organ donor?
4.	___	___	Do you want to donate $1.00 to the Blindness Education Screening and Treatment Program?
5.	___	___	Do you want to support the Glenda Dawson Donate Life Texas donor registry? If yes, please indicate a donation amount of $1 or more
			$_______.00.
6.	___	___	Do you want to support Texas Veterans? If yes, please indicate a donation amount of $1 or more $_________.00.
7.	___	___	Do you want to support survivors of sexual assault? If yes, please indicate a donation amount of $1 or more $_________.00 to help fund the testing
			of sexual assault evidence collection kits (rape kits).
8.	___	___	Do you want to support the issuance of a DL/ID for foster or homeless youth? If yes, please indicate a donation amount of $1 or more
			$_________.00 to exempt this population from paying any fees.

REQUIRED INFORMATION FROM DRIVER LICENSE APPLICANTS ONLY (FOR CONFIDENTIAL USE OF THE DEPARTMENT ONLY)

MEDICAL HISTORY QUESTIONS

YES NO

1. ___ ___ Do you currently have or have you ever been diagnosed with or treated for any medical condition that may affect your ability to safely operate a motor vehicle? Examples, including but not limited to: Diagnosis or treatment for heart trouble, stroke, hemorrhage or clots, high blood pressure, emphysema (within the past two years) • progressive eye disorder or injury (i.e., glaucoma, macular degeneration, etc.) • loss of normal use of hand, arm, foot or leg • blackouts, seizures, loss of consciousness or body control (within the past two years) • difficulty turning head from side to side • loss of muscular control

•stiff joints or neck • inadequate hand/eye coordination • medical condition that affects your judgment • dizziness or balance problems • missing limbs Please explain and identify your medical condition: ____________________________________________________________________________________________________________

2.	___	___	Do you have a mental condition that may affect your ability to safely operate a motor vehicle? If yes, how? Please explain:
			________________________________________________________________________________________________________________________________________________________________________
3.	___	___	Have you ever had an epileptic seizure, convulsion, loss of consciousness, or other seizure?
4.	___	___	Do you have diabetes requiring treatment by insulin?
5.	___	___	Do you have any alcohol or drug dependencies that may affect your ability to safely operate a motor vehicle or have you had any episodes of
			alcohol or drug abuse within the past two years?
6.	___	___	Within the past two years have you been treated for any other serious medical conditions? Please explain:
			________________________________________________________________________________________________________________________________________________________________________
7.	___	___	Have you EVER been referred to the Texas Medical Advisory Board for Driver Licensing?

DL-77 (Rev. 7/2020)

APPLICATION CONTINUED ON BACK

VEHICLE REGISTRATION AND INSURANCE INFORMATION
1.	___	___	Do you own a motor vehicle that is required to be registered? (Texas Transportation Code section 502.040)
2.	___	___	Do you own a motor vehicle that is required to have liability insurance OR other proof of financial responsibility in compliance with the Motor
			Vehicle Safety Responsibility Act? (Texas Transportation Code section 601.051)


APPLICANT IS APPLYING FOR A HARDSHIP DRIVER LICENSE UNDER THE FOLLOWING PROVISION(S):


____ 1.	An unusual economic hardship on the family of the minor.
____ 2.	A death-related emergency: Name of Deceased: ______________________________________________________________________________________________
	Date of Death:________________	Relationship to Deceased: _________________________________________________________________________________
____ 3.	Sickness or illness or disability of family members (PHYSICIAN’S STATEMENT REQUIRED)
	Name of Family Member:_______________________________________________		Relationship:_______________________________________________________
	Family Physician:______________________________________________________		Phone Number: ____________________________________________________
____ 4.	Enrollment in a Vocational Education Program (CERTIFICATION FROM SCHOOL REQUIRED)
	School:_______________________________________________________________		Phone Number: ____________________________________________________
	Address of School:____________________________________________________		City: ______________________________________________________________

Time Classes: Start:______________ End:______________	Days: ___ MON	___ TUES	___ WED ___ THUR ___ FRI ___ SAT ___ SUN

ADDITIONAL INFORMATION
Does the applicant have a Texas Learner License, Provisional license or ID card? ___ YES		___ NO	If YES, # _____________________________________________฀

Has the applicant ever applied for a Hardship Driver License? ___ YES ___ NO Where? ________________________________________________________________฀

Has the applicant completed a required driver education course? ___ YES ___ NO (Choose one) ___ Classroom ___ Driving ___ Both

FATHER’S NAME:___________________________________________________________ License Number:______________________________________

Employed by:______________________________________ Address: _______________________________________________________________________________________฀

Work Hours:______________________________________ Work Phone:______________________________________

MOTHER’S NAME:___________________________________________________________ License Number:______________________________________

Employed by:______________________________________ Address: _______________________________________________________________________________________฀

Work Hours:______________________________________ Work Phone:______________________________________

List all other members of the household: (Use extra page if necessary.)

Name:______________________________________________________ License #:________________________________ Relationship: ______________________________

Explain all necessary driving of applicant and why others cannot perform this function: NOTE: TRAVEL TO PARTICIPATE IN SCHOOL ACTIVITIES SUCH AS BAND,

SPORTS, ETC., WILL NOT BE CONSIDERED A SUFFICIENT REASON TO ESTABLISH AN UNUSUAL ECONOMIC HARDSHIP. (TAC Title 37 §15.28)

Use extra page if necessary.

Texas law requires the Texas Department of Public Safety to provide every minor applicant (under age 18) and cosigner, for a driver license in Texas, educational information concerning state laws relating to distracted driving, driving while intoxicated, driving by a minor with alcohol in the minor’s system, and the implied consent law. The minor applicant and cosigner must acknowledge receipt of this information prior to issuance of any driver license or permit.

I hereby acknowledge receipt of this information.

_______________________________________________________________	_______________________________________________________________	__________________________
Minor Applicant	Parent/Legal Guardian	Date of Receipt

PARENTAL AUTHORIZATION

TO THE PARENT: In making this application as parent or guardian of _________________________________________________________________ ,

I take full responsibility for the authorization of said minor to be issued a driver license. I understand that the Department may make any investigation necessary to confirm or deny any information contained in this application or information concerning early enrollment authority in a driver education course as provided in Texas Transportation Code section 521.223.

_______________________________________________________________	_________________________________________	__________________________
Usual Written Signature of Parent or Guardian	Driver License Number	Date

NOTICE: The information on this application is required by the Texas Driver License Act, Texas Transportation Code Chapter 521. Failure to provide the information is cause for refusal to issue a driver license or identification card, and in some cases, cancellation or withdrawal of driving privileges. False information could also lead to criminal charges with penalties of a fine up to $4,000.00 and/or jail.

SOCIAL SECURITY NUMBER COLLECTION DISCLOSURE

Disclosure of your social security account number is mandatory for identification card and driver license applicants, but voluntary for election identification certificate applicants. This information is solicited pursuant to 42 U.S.C. section 405(c)(2)(C)(i), 42 U.S.C. section 666(a)(13)(A), 6 C.F.R. section 37.11(e), 49 C.F.R. section 383.153, Texas Family Code section 231.302(c)(1), and Texas Transportation Code sections 521.142 and 522.021. The Department will use social security number information for identification purposes and will only release the number as statutorily authorized by Texas Transportation Code section 521.044.

DO NOT WRITE BELOW THIS LINE – FOR DEPARTMENT USE ONLY

Application (Select one): ___ Approved ___ Rejected _____________________________________________________________	________________	_________________
Signature	Date	ACID#

JUSTIFICATION /RESTRICTIONS:______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

DL-77 (Rev. 7/2020)

Use extra page if necessary.

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Form Information

Fact Name	Details
Application Requirement	All information must be filled out in ink.
Application Holding Period	Applications are held for a maximum of 90 days.
Refund Policy	The Department of Public Safety (DPS) does not refund payments once the application is submitted.
Eligibility Criteria	A hardship license may be issued if it prevents unusual economic hardship, addresses a family illness, or supports vocational education.
Driver Education Requirement	Completion of an approved driver education course is mandatory.
Governing Laws	Texas Transportation Code sections 521.223 and 521.224 govern the hardship license application.
Emergency Contacts	Applicants can provide up to two emergency contacts for injury or death situations.
Medical History Disclosure	Applicants must disclose any medical conditions that could affect driving ability.
Parental Authorization	Parents or guardians must authorize the issuance of a license for minor applicants.
Social Security Number Requirement	Disclosure of the Social Security number is mandatory for identification purposes.

Detailed Guide for Filling Out Texas From Dl 77

Filling out the Texas Form DL-77 is a straightforward process that requires careful attention to detail. Once completed, this form will be submitted to the Texas Department of Public Safety as part of your application for a hardship driver license. Ensure that all information is accurate and legible, as the application will only be held for 90 days, and any errors may delay the process.

Gather Necessary Information: Before starting, collect all required personal and contact information, including your Social Security Number, date of birth, and details about your family and household.
Fill Out Applicant Information: Begin with your last name, first name, middle name, and suffix. Include your birth surname, Social Security Number, date of birth, sex, height, weight, eye color, hair color, race, and ethnicity.
Provide Place of Birth: Indicate the city, state, county, and country where you were born.
Contact Information: Enter your residence address, mailing address (if different), home phone, other phone, and email address.
Emergency Contacts: If you wish to provide emergency contacts, list up to two names, their phone numbers, and addresses.
Answer Required Questions: Respond to the yes/no questions regarding citizenship, health conditions, and donation preferences. Ensure that all questions are answered honestly.
Medical History: Complete the medical history section by answering questions about any medical conditions that may affect your ability to drive safely.
Vehicle Registration and Insurance: Indicate whether you own a motor vehicle that is required to be registered and whether it has liability insurance.
Specify Hardship Reason: Select the reason for applying for a hardship driver license and provide any necessary details, such as names and relationships.
Additional Information: Provide information about any existing Texas licenses, previous hardship applications, and completion of driver education courses.
Parental Authorization: If you are under 18, have your parent or guardian sign and date the parental authorization section.
Review the Application: Carefully check all sections for completeness and accuracy before submitting.

Obtain Answers on Texas From Dl 77

What is the Texas DL-77 form?
The Texas DL-77 form is an application for a Hardship Driver License. This license is available to individuals who can demonstrate that not having a driver’s license would create an unusual economic hardship for their family, be necessary due to a family member's illness, or be required for participation in a vocational education program.
Who is eligible to apply for a Hardship Driver License?
Eligibility for a Hardship Driver License includes individuals who meet one of the following criteria:
- Experience unusual economic hardship.
- Need a license due to a family member's illness.
- Are enrolled in a vocational education program that requires a driver’s license.
What information is required to complete the DL-77 application?
Applicants must provide personal information, including:
- Full name and birth details.
- Contact information, including residence and mailing addresses.
- Emergency contacts.
- Details regarding any medical conditions that may affect driving ability.
Can I receive a refund if I submit the application and change my mind?
No, the Texas Department of Public Safety (DPS) does not offer refunds once the application has been submitted. It is essential to ensure all information is accurate and complete before submission.
What happens after I submit my DL-77 application?
Once the application is submitted, it will be reviewed by the DPS. The application is held for 90 days, during which the applicant may be contacted for additional information or clarification. After the review, the application will either be approved or rejected.
Is there a requirement for driver education?
Yes, applicants must complete an approved driver education course to qualify for a Hardship Driver License. This requirement ensures that all drivers have the necessary skills and knowledge to operate a vehicle safely.

Common mistakes

When completing the Texas Form DL-77 for a Hardship Driver License, many applicants inadvertently make mistakes that can delay the process or even result in rejection. Understanding these common pitfalls can help ensure a smoother application experience.

One frequent error is the use of the wrong writing instrument. The instructions clearly state that all information must be filled out in ink. Many applicants mistakenly use pencil or other erasable mediums, which can lead to the application being deemed invalid. Always double-check your writing tool before starting.

Another common mistake involves leaving sections blank. Each part of the application is crucial, and failing to provide complete information can raise red flags. For instance, if you skip the section asking for your Social Security Number, the application may be held up. It’s essential to read each question carefully and provide thorough answers.

Some applicants also overlook the requirement to provide accurate contact information. If the Department of Public Safety (DPS) cannot reach you due to incorrect phone numbers or email addresses, your application may face unnecessary delays. Ensure that all contact details are current and correct.

Providing incomplete or unclear medical history is another mistake that can complicate your application. If you answer "yes" to any medical condition question, be prepared to explain your condition in detail. Vague responses can lead to confusion and further inquiries from the DPS.

Additionally, many applicants fail to check the appropriate boxes for citizenship or health conditions. Neglecting to answer these questions can result in automatic disqualification. It’s vital to read each question and respond accurately.

Some people mistakenly think that all required documents can be submitted later. However, the DL-77 form requires certain documentation, such as a physician’s statement or school certification, to be included with the application. Missing these documents can lead to immediate rejection.

Another error is not keeping copies of the submitted application. In the event of a follow-up or if you need to reference your application later, having a copy can be invaluable. Always retain a personal copy for your records.

Finally, applicants often underestimate the importance of the signature section. Failing to sign the application or having a parent or guardian sign without proper identification can lead to delays. Make sure that all required signatures are present and legible.

By being aware of these common mistakes, applicants can navigate the Texas Form DL-77 process more effectively. Taking the time to review the application thoroughly before submission can save you from unnecessary complications and ensure a smoother path to obtaining your Hardship Driver License.

Documents used along the form

The Texas DL-77 form is a crucial document for those seeking a hardship driver license in Texas. However, several other forms and documents often accompany this application to ensure a complete and accurate submission. Understanding these additional documents can streamline the process and help applicants meet all necessary requirements.

DL-101: Medical Condition Statement - This form is required if the applicant has a health condition that may affect their ability to communicate with law enforcement. A physician must complete it to provide necessary medical insights.
DL-103: Driver Education Certificate - If the applicant has completed a driver education course, this certificate serves as proof. It's essential for demonstrating compliance with state educational requirements.
DL-77A: Parental Authorization Form - For minors, this form requires a parent or guardian's signature, confirming their responsibility for the applicant’s driving activities and compliance with Texas laws.
DL-74: Driver License Application - This general application form is used for various types of driver licenses. It collects essential information about the applicant, including personal details and driving history.
DL-70: Identification Card Application - If the applicant does not have a driver license, this form can be submitted to apply for a state identification card, which may be necessary for identification purposes.
DL-126: Vision Exam Report - A vision exam is mandatory for all driver license applicants. This form documents the results of the vision test and must be signed by a licensed optometrist or ophthalmologist.
DL-77B: Emergency Contact Form - This optional form allows the applicant to provide emergency contact information, ensuring that someone can be reached in case of an accident or emergency.
Financial Responsibility Affidavit - This document verifies that the applicant has the necessary insurance coverage or financial responsibility in compliance with Texas law, particularly for vehicle operation.
Proof of Residency - Applicants must provide documentation that verifies their Texas residency, such as a utility bill or lease agreement, to support their application.

Each of these documents plays a vital role in the application process for a Texas hardship driver license. Being prepared with the necessary forms not only expedites the review process but also increases the likelihood of a successful application. Understanding what is required can make a significant difference in navigating the complexities of obtaining a driver license in Texas.

Similar forms

Texas Driver License Application (DL-14) - Similar to the DL-77, the DL-14 form is used to apply for a standard driver license in Texas. Both forms require personal information, including identification details and residency status, and they help the Texas Department of Public Safety assess eligibility for driving privileges.
Texas Identification Card Application (DL-100) - This document serves those who need a state-issued ID rather than a driver license. Like the DL-77, it collects personal information and serves as a means of identification for various purposes, including voting and accessing services.
Texas Learner License Application (DL-20) - The DL-20 form is for individuals seeking a learner's permit. It shares similarities with the DL-77 in that it includes information about the applicant's age, residency, and parental consent, as well as requirements for driver education.
Texas Provisional License Application (DL-30) - This form is intended for drivers who have completed their learner's permit phase. It mirrors the DL-77 in that both applications require proof of completed driver education and parental approval for applicants under 18 years old.
Texas Medical Advisory Board Form (DL-101) - This form is relevant for applicants with medical conditions that may affect their driving. Like the DL-77, it addresses health-related questions to ensure the safety of the applicant and others on the road.

Dos and Don'ts

When filling out the Texas Form DL-77 for a Hardship Driver License, it's crucial to follow specific guidelines to ensure your application is processed smoothly. Here’s a list of things you should and shouldn't do:

Do use blue or black ink to fill out the form. This ensures clarity and legibility.
Don't leave any required fields blank. Every section must be completed to avoid delays.
Do provide accurate personal information, including your full name, address, and contact details.
Don't submit false information. Misrepresentation can lead to severe penalties.
Do include any necessary documentation, such as a physician's statement if required.
Don't forget to sign and date the application. An unsigned form will not be accepted.
Do double-check your application for errors before submitting it. A careful review can save you time.
Don't assume that your application will be processed immediately. Be aware that it may take time for review.

Following these guidelines can help you navigate the application process more effectively and increase your chances of approval.

Misconceptions

Understanding the Texas DL-77 form can be challenging, and several misconceptions often arise. Here are ten common misunderstandings about this form:

Anyone can apply for a Hardship License. Many believe that any applicant can qualify for a Hardship License. However, eligibility is limited to specific circumstances, such as unusual economic hardship or family illness.
The application fee is refundable. Some applicants think they can get their application fee back if their request is denied. In reality, once submitted, the fee is non-refundable.
All information can be filled out in pencil. It is a common misconception that using pencil is acceptable. The application must be completed in ink to be valid.
There is no time limit on application processing. Applicants often assume their application will be processed indefinitely. In fact, the Texas Department of Public Safety holds applications for only 90 days.
Only minors can apply for a Hardship License. While many applicants are minors, adults can also apply if they meet the necessary criteria for hardship.
Medical information is optional. Some believe that providing medical history is optional. However, it is a required part of the application process for those who may have health conditions affecting their ability to drive.
Emergency contacts are not important. Many applicants overlook the emergency contact section. Providing this information is crucial for safety and communication purposes.
Previous driving violations disqualify you automatically. Some think that any past violations automatically disqualify them from receiving a Hardship License. This is not necessarily true; each application is considered on a case-by-case basis.
Donations on the form are mandatory. Applicants may feel pressured to make donations listed on the form. However, these contributions are entirely voluntary.
Once submitted, you cannot make changes. Many believe that they cannot alter their application after submission. In fact, applicants can request changes as long as the application is still under review.

By addressing these misconceptions, applicants can better navigate the process and understand their rights and responsibilities when applying for a Hardship Driver License in Texas.

Key takeaways

Here are some key takeaways about filling out and using the Texas Form DL-77 for a hardship driver license:

Complete in Ink: Always fill out the form using ink to ensure legibility.
90-Day Limit: Applications are only held for 90 days, so submit promptly.
No Refunds: Once submitted, the Texas Department of Public Safety (DPS) does not refund payments.
Eligibility Criteria: A hardship license may be issued if it prevents unusual economic hardship, is needed for a family member’s illness, or is required for vocational education.
Driver Education Required: Completing an approved driver education course is mandatory for applicants.
Emergency Contacts: You can provide up to two emergency contacts in case of injury or death.
Medical History: Be prepared to disclose any medical conditions that may affect driving ability.
Financial Responsibility: Ensure that you own a vehicle that is registered and insured as required by Texas law.
Parental Authorization: If under 18, a parent or guardian must authorize the application and take responsibility.
Educational Information: Minor applicants and their cosigners must receive educational materials on driving laws before issuance.

Understanding these points will help streamline the application process and ensure compliance with Texas regulations.