Fillable Form Pennsylvania Driver's License Application Form

What is the Pennsylvania Driver's License Application Form?

Form DL-180R, Application for Pennsylvania Non-Commercial Driver’s License By Out-of-State Non-CDL Driver, or also commonly referred to as the Pennsylvania Driver's License Application Form is used and filed by citizens of the State of Pennsylvania who are first-time driver’s license applicants. Applicants must apply in person, as physical examinations are required. The form is valid for one year from the date of physical examination.

Requirements to apply for a Pennsylvania driver’s license

General Requirements:

• Applicants must be at least 16 ½ years old. For minors aged 18 years below, their parents or guardians need to provide their consent.
• Out-of-state licenses should not be expired for more than 6 months prior to the application; otherwise, they cannot be transferred.

For U.S. Citizens:

• Original Social Security Card and,
• One of the following:
  • Birth certificate with raised U.S. seal — No other birth documents will be accepted.
  • Certificate of U.S. Citizenship
  • Certificate of Naturalization
  • Valid U.S. Passport — Only valid U.S. Passports are accepted.

For Non-U.S. Citizens:

• Original US Citizenship and Immigration documents indicating current lawful immigration status
• Valid Passport, dependent on the status
• Social Security Card or Social Security Number ineligibility letter — Must be original and not a photocopy; a laminated card is not accepted.

All documents should have identical information or any association to validate their legitimacy. Prepare additional or backup documentation in case no connection is established.

Residency Requirements (for 18 years of age and older):

• Present any two of the following:
  • Tax records
  • Lease agreements
  • Mortgage documents
  • Wage and Tax Statement Form, Form W-2
  • Current weapons permit — For U.S. citizens only.
  • Current utility bills — Such as water, gas, electric, or cable bills.

Proof of residency documents should have the applicant's name and Pennsylvania street address.

How to fill out the Pennsylvania Driver's License Application Form?

The Pennsylvania Driver’s Licence Application Form consists of five sections to be filled out with the applicant’s information.

Section A

This section requires your basic information.

Name

Enter your full legal name.

Date of Birth

Enter your date of birth in the following format: MM/DD/YYYY.

Height

Enter your height in feet and inches.

Social Security Number

Enter your Social Security Number.

Sex

Enter your sex.

Telephone Number

Enter your telephone number that is available from 8:00 A.M. to 4:00 P.M.

Eye color

Mark the appropriate box to determine your natural eye color. You may select:

• Blue
• Brown
• Green
• Hazel
• Pink
• Black
• Gray
• Dichromatic
• Other — Specify your eye color.

Street Address

Enter your Pennsylvania street address. You may add your Post Office Box number but it cannot be used as your only address.

Section B - All Statements Must Be Answered

Mark the appropriate boxes to determine any health conditions you may have. You may select:

• Neurological disorders
• Neuropsychiatric disorders
• Circulatory disorder
• Cardiac disorder
• Hypertension
• Uncontrolled epilepsy
• Uncontrolled diabetes
• Cognitive impairment
• Alcohol abuse
• Drug abuse
• Conditions causing repeated lapses of consciousness — Specify your condition. If seizure disorder, enter the date of last seizure.
• Impairment or amputation of an appendage — If so, list your conditions.
• Other — Specify other health conditions you may have.

Item 1

Mark “Yes” if you have ever held a PA Driver's License/Learner's Permit/ID Card in this or any other name(s) and enter your previous record number and/or name(s); otherwise, mark “No.”

Item 2

Mark “Yes” if you have ever held or possessed a Driver's License (DL)/Learner's Permit (LP)/Photo Identification Card (ID) from any other state, and enter the state, DL/LP/ID number, and name; otherwise, mark “No.”

Item 3

Mark “Yes” if your right to apply for a license or your privilege to operate a vehicle in this or any other state is currently suspended or revoked, and enter the state, date, and reason; otherwise, mark “No.”

Item 4

Mark “Yes” if you have any pending criminal charges or driving violations in this state or any other state which may carry a possible penalty of suspension or revocation of your driver's license or driving privilege, and enter the state, date, and reason; otherwise, mark “No.”

Item 5

Mark “Yes” if you are currently required, or have been cited for a violation that will require you to only drive vehicles equipped with an Ignition Interlock device; otherwise, mark “No.”

Section C — Consent of Parent, Guardian, Person in Loco Parentis or Spouse at least 18 Years of Age

Your parent or guardian must fill out this section if you are below 18 years of age.

Mark the appropriate box to determine your relationship with the minor. You may select:

• Parent
• Guardian
• Person in Loco Parentis
• Spouse at least 18 years of age

Mark the appropriate box to determine what you are not consenting to. You may select:

• I do not give consent.
• I do not give consent for applicant’s request for Organ Donor designation.

Sign Here

Affix your signature.

Section D - Authorization and Certification

Mark the appropriate boxes to determine the situations you are authorizing. You may select:

• For Veterans wishing to add the Veterans Designation to their Driver's License or ID Card: I certify under penalty of law that I am a qualified applicant and hereby request it be added to my product.
• For minors: I am under the age of 18 years and I hereby request Organ Donor designation on my PA Driver's License.
• I wish to contribute $3.00 to the Organ Donation Awareness Trust Fund.
• I wish to contribute $3.00 to the Veterans' Trust Fund.

Sign Here

Affix your signature and enter the date of signing.

Paid By

Mark the appropriate box to determine your type of payment. You may select:

• Check
• Money Order

Total

Enter the amount of payment.

Section E — Exam Report Vision Screening

This section shows the exam report regarding your eye screening exam.

• Mark “Yes” if you have 20/40 vision or less in better eyes with correction; otherwise, mark “No.”
• Mark “Yes” if you have a Report of Eye Examination attached; otherwise, mark “No.”
• Mark the box if you are “Qualified with Restrictions.” Then, select the appropriate box to determine a solution:
  • Corrective Lenses
  • Other — Specify the solution.
• Mark the box if you are “Qualified without Restrictions.”

Compete all items in the next part:

• Enter the uncorrected and corrected grade of your right eye.
• Enter the uncorrected and corrected grade of your left eye.
• Enter the uncorrected and corrected grade of both eyes.
• Enter the uncorrected and corrected grade of your right and left fields.

Mark the appropriate box to determine the class to be endorsed on the driver’s Pennsylvania license.

• A
• B
• C
• M

Guidelines in Filing the Pennsylvania Driver's License Application Form

• The Pennsylvania Driver’s License Application Form allows veterans to add a Veteran Designation to their driver’s licenses. To qualify, you must have served in the United States Armed Forces, including a reserve component or the National Guard, and have been discharged or released from such service under conditions other than dishonorable.

• A Pennsylvania Non-Commercial Driver’s License is only granted upon fulfilling all requirements and surrendering all existing valid licenses that the applicant has from this or any other state.

• The final approval of the application of this form would depend on the verification of the applicant’s driver record history. For any instances that there are indeed outstanding violations, the application would be subject to cancellation and recall.

• Any violation in processing the Pennsylvania Driver’s License Application Form may result in penalties and sanctions, ranging from paying a fine of $100 to imprisonment of up to 5 years, depending on the level of offense. The following activities are prohibited:
  • Exhibiting or causing a permit to be exhibited, or possessing any recalled, canceled, suspended, revoked, fictitious, or fraudulently altered driver’s license
  • Lending a driver’s license, or permitting another person to use a license
  • Representing as one’s own any driver’s license not issued to the person
  • Failure or refusal to surrender to the department upon lawful demand a recalled, canceled, suspended, revoked, fictitious, or fraudulently altered driver’s license