Fillable Form DLD6a Utah Driver License Application Form

What is the Utah Driver License Application Form?

Form DLD6a or the Utah Driver’s License Application form is used to obtain a driver's license. A driver’s license permits an individual to access public roads and operate one or more vehicles.

Who is eligible for a Utah Driver’s License?

• Must be a resident of Utah.
• Must be 18 years of age or older.

How to fill out the Utah Driver’s License Application form?

UT LICENSE NUMBER

Enter your Utah license number.

UT ID NUMBER

Enter your Utah ID number.

FULL LEGAL NAME

Enter your full legal name in this format: Last name, First name, Middle, and Suffix (if there’s any).

DATE OF BIRTH

Enter your birth date in this format: mm/dd/yyyy.

SOCIAL SECURITY NUMBER/ITIN

Provide your social security number (SSN) or ITIN.

*Your SSN will remain confidential and will not be shown on your driver’s license or ID card.

UT RESIDENCE ADDRESS

Enter the street name, apartment/suite number (if there’s any), city, state, and ZIP code.

MAILING ADDRESS

If you have a different address, enter the P.O box number, street number, street name, apartment number (if there’s any), city, ZIP code.

EMAIL ADDRESS

Enter your email address.

PHONE NUMBER

Enter your active phone number.

HEIGHT

Enter your height in feet and inches.

WEIGHT

Enter your weight.

HAIR COLOR

Enter your hair color.

EYE COLOR

Enter the color of your eyes.

GENDER

Enter your gender.

APPLICANT’S PLACE OF BIRTH

Enter the state or country where you were born.

MOTHER’S MAIDEN NAME

Provide your mother’s last name before marriage in this format: Last name and First name.

APPLICANTS MUST ANSWER ALL QUESTIONS

• Mark YES if you are a U.S. citizen. Otherwise, mark NO.
• Mark YES if you are a legal permanent resident alien or a U.S National. Otherwise, mark NO.
• Mark YES if you are a citizen of another country and have evidence of a lawful presence in the United States. Otherwise, mark NO.
• Mark YES if you would like to register your desire to help others by being an organ, eye, and tissue donor. Otherwise, mark NO.
• Mark YES if you are a U.S military veteran. Otherwise, mark NO.
  • For U.S military veterans, mark YES if you authorize sharing this information with the Utah Division of Veterans Affairs for the purpose of identifying veterans and disseminating veteran benefit information. Otherwise, mark NO.

• Mark YES if you would like to include your veteran status on your driver’s license or ID card. You must provide a DD214 or Veterans Record/Notice of Separation indicating your honorable discharge. Otherwise, mark NO.

• Mark YES if you are required to register as a sex offender with the State of Utah, any other state, or with the U.S government.
• Mark YES if you have been issued a driver’s license by another state, country, or province. If yes, indicate the states/countries/provinces, driver’s license number, and expiration date.
• For CDL drivers, mark YES if you have been licensed in another state within the last 10 years. If yes, indicate the state(s) and driver’s license number.
• Mark YES if your driving privilege has been suspended, revoked, canceled, denied, or disqualified. If yes, indicate the state and ID number. Then explain why.

PRINT THE NAME OF THE PERSON SIGNING FOR MINOR

Enter the name of the person who’s signing for the minor, either the father, mother, or guardian.

DONATION

• Mark YES if you wish to contribute a $2 donation to the “Friends for Sight” fund. Otherwise, mark NO.
• Mark YES if you wish to contribute a $2 donation to educate people about organ, eye, and tissue donation. Otherwise, mark NO.
• Mark YES if you wish to contribute a $1 donation to the “Mobility Assistance Fund.” Otherwise, mark NO.
• Mark YES if you claim to be disabled under the Americans with Disabilities Act. Otherwise, mark NO.
• Mark YES if you claim to be indigent and are applying for an ID card for voting purposes. Otherwise, mark NO.

SECOND PAGE

UT LICENSE NUMBER

Enter your Utah license number.

UT ID NUMBER

Enter your Utah ID number,

Answer the health conditions you incurred in the last 5 years as follows:

Diabetes

Mark YES if you take insulin. Otherwise, mark NO.

Cardiovascular

Mark YES if you have an uncontrolled heart condition. Otherwise, mark NO.

Mark YES if you have an implantable cardioverter-defibrillator (ICD). Otherwise, mark NO.

Mark YES if you have lost consciousness or fainted in the last 5 years. Otherwise, mark NO.

Pulmonary

Mark YES if you have a lung condition. Otherwise, mark NO.

Mark YES if an inhaler is the only prescribed in your condition. Otherwise, mark NO.

Mark YES if you use supplemental oxygen. Otherwise, mark NO.

Neurologic
Mark YES if you have or had a neurological condition, such as dementia, strokes, Alzheimer’s, traumatic brain injury, multiple sclerosis, or Parkinson’s. If none, mark NO.

Epilepsy

Mark YES if you have or had seizures in the last 5 years. Otherwise, mark NO.

Mark YES if you have or had a commercial driver, anytime during your lifetime. Otherwise, mark NO.

Learning and Memory

Mark YES if you have learning and memory difficulties that may interfere with driving safety. Otherwise, mark NO.

Mental Health Conditions

Mark YES if you have mental health conditions such as schizophrenia, severe anxiety, or severe depression. Otherwise, mark NO.

Alcohol and Other Drugs

Mark YES if you use alcohol excessively, misuse prescription drugs, or use illegal drugs. Otherwise, mark NO.-

Mark YES if you have been treated for alcohol or chemical dependency, or has treatment been recommended by a medical professional. Otherwise, mark NO.

Vision

Mark YES if you are required to wear glasses or contact lenses for driving. Otherwise, mark NO.

Mark YES if your visual acuity is worse than 20/40 in the better eye, even with corrective lenses. Otherwise, mark NO.

Mark YES if you have a degenerative or progressive eye condition. Otherwise, mark NO.

Mark YES if you have experienced a decrease in peripheral vision. Otherwise, mark NO.

Musculoskeletal

Mark YES if you have loss or paralysis of all parts of a limb or severe arthritis. Otherwise, mark NO.

Mark YES if you are new or changed in the past 5 years. Otherwise, mark NO.

Mark YES if have this present longer than 5 years. Otherwise, mark NO.

Alertness or Sleep Disorders

Mark YES if you have a condition that produces abnormal sleepiness. Otherwise, mark NO.

Other

Mark YES if there any other health problems or use of medications that might interfere with driving ability or safety or control of a vehicle. Then, explain your other health problems. Otherwise, mark NO.

Note: A “Yes” answer might request you a follow-up question to assess your health conditions thoroughly.

VOTE REGISTRATION

Mark YES if you authorize the use of information in this form for registration purposes. Otherwise, mark NO.

Mark YES if you would like to be registered as an absentee voter to receive ballots by mail. Otherwise, mark NO.

Mark YES if you would like to request that your voter registration record be classified as a private record.

Political Party

Choose which political party you would like to be part of:

• Constitution
• Democratic
• Green
• Independent American
• Libertarian
• Republican
• United Utah
• Unaffiliated
• Other (specify)

What are the requirements for voter registration and pre-registration in Utah?

• Must be a citizen of the United States and have resided in Utah for 30 days before the next election.
• Must be 16 or 17 years old to pre-register or at least 18 years old on or before the general election to register to vote.

You will only be allowed to vote in a voting precinct for the first time or to vote during the early voting period before the date of the election. You must bring the following:

1. A valid form of photo identification that shows your name, photograph, and current address; or

2. Two (2) different forms of identification showing your name and current address.

CITIZENSHIP AFFIDAVIT/VOTER DECLARATION

Read the disclosure statements and make sure that the information you provided is factual and truthful. False allegations declared in this form will be subject to legal consequences under the penalties of perjury.

Sign and date to register to vote.

Submit the completed form to the examiner and do not fill out the remaining fields.