Driver & Traffic Safety Education Teacher Request For Duplicate MV-283 Card Form
Directions: Teachers requesting a duplicate MV-283 card must complete and submit the MV-283 request form below. Blank fields should be filled out electronically, the forms should be hand signed in blue ink and then mailed to the address listed below along with the following materials:
a copy of the requestor’s driver’s license,
official driving abstract if the requestor holds an out of State driver’s license (dated within last 30 days), and;
a copy of the requestor’s New York State teaching certification if requesting an MV-283 with an “All Approved” designation.
Individuals requesting a duplicate MV-283 card will be subject to a review and assessment of their driving record for a period of 24 months prior to the date of receipt of this form. The review and assessment of an individual’s driving record will be used to determine the status of their MV-283 card as well as their duplicate request. The criteria used to assess a requestor’s driving record are based on the “Drivers License Criteria For Renewing a Driving School Instructor Certificate”.
Please note the mailing address listed below must appear the same as the mailing address on record with the requestor’s driver’s license client identification number. Requests with incongruous mailing addresses will not be processed until the requestor updates this information with the Department of Motor Vehicles (DMV).
Last First MI
Mailing Address: FAX: ( )
City, State: , Zip:
Telephone 1: ( ) Telephone 2: ( ) Telephone 3: ( )
Please indicate which type of MV-283 card you were previously issued.
Date card was originally issued (if known):
MV-283 card number (if known):
Driver’s License Client Identification Number:
Signature of Applicant: __________________________________________ Date:
Send an original copy of this form along with all other required materials to the New York State Education Department at the address below.
New York State Education Department
Duplicate MV-283 Request
Career & Technical Education Office
Driver & Traffic Safety Education Room 315 EB
89 Washington Ave.
Albany, NY 12234