Traffic School Written Declaration Form

Traffic School Written Declaration Form
Submit your written declaration for traffic school or citation resolution. Please complete all required fields accurately.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Citation or Ticket Number
Date of Citation or Violation
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Issuing Agency or Court
Vehicle Make and Model
Please provide your written declaration statement
Have you previously attended traffic school for a citation within the past 18 months?
Signature
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