Information about the Wisconsin

Driver License (DL) Application (form MV3001)

You will need to visit a DMV service center and present an MV3001 application when you:
• apply for an original or duplicate* driver license or instruction permit
• renew an existing driver license
• apply for an occupational license

An application may only be submitted through the mail if you are unable to renew or obtain a
duplicate driver license because you are a Wisconsin resident who is temporarily out-of-state.

More information about:

• renewing when out of state
• fees
• applying for a license

* Note: You may be eligible to order a duplicate driver license online rather than visit a DMV service
center. See our online duplicate driver license application for further information.
 WISCONSIN DRIVER LICENSE (DL) APPLICATION An unexpired Wisconsin
Wisconsin Department of Transportation driver license is acceptable
MV3001 7/2021 Ch. 343 Wis. Stats. photo ID for voting.
Clear Form (s. 5.02(6m) Wis. Stats.)
Acceptable proof of name and date of birth, legal presence, identity and Wisconsin residency are required. Please see DOT publication
BDS316 or wisconsindmv.gov/dl-docs for a list of acceptable documents.
 ALL applicants, complete the top section on back. NOTICE TO MALES AGE 18–25  By submitting this application, you
If under age 18, also complete the ‘UNDER AGE 18’ section below. consent to be registered with the Selective Service System, if required
by Federal law. You also authorize the Department of Transportation to
CDL applicants, complete the ‘CDL APPLICANT ONLY’ section below.
  forward any information contained in this application that is requested by the
Your Federal Medical Certificate is required unless you drive a school bus
Selective Service System for the purpose of registering you as provided in s.
or drive for a political subdivision.
343.14(2)(em) and s. 343.234 Wis. Stats.
DONOR  Check the box if you wish to help others by donating your organs,
WARNING  Any applicant for a driver license who presents fraudulent
tissue and eyes upon your death. Your gift will be used to save and improve
or altered documents or makes a false statement to the issuing officer or
lives through transplantation, therapy, research or education. If you are at
agency, may be subject to a fine of not more than $1,000, imprisonment for
least 18, checking the box indicates your legal consent for donation. You do
not more than six months or both. The driver license privilege may also be
not have to answer this question to obtain a license.
revoked for one year. (s. 343.14(5) Wis. Stats.)
ADA  The Wisconsin Department of Transportation complies with the Ameri-
cans with Disabilities Act (ADA). OPT OUT  Under Wisconsin open records laws, WisDOT must provide
information from its records to requesters. If you do not want your name and
INVISIBLE DISABILITY  Notice to law enforcement form: address included in requests we receive for ten or more records, you may ask
wisconsindmv.gov/inv-dis or at DMV Service Centers. WisDOT to withhold your name and address from those lists by checking the
SOCIAL SECURITY NUMBER (SSN)  If you have a SSN, you must provide box on the application.
it (s. 343.14(2)(bm) Wis. Stats.). Your SSN may be used for purposes INSURANCE  No person may operate a motor vehicle in Wisconsin unless
authorized by law and to link your driver license and vehicle registration the owner or driver of the vehicle has liability insurance in effect for the
records. Your SSN must correspond with the number issued by the Social vehicle being operated and carries proof of insurance whenever driving.
Security Administration. Federal regulation 49 CFR, Part 383.153 requires a Failure to have insurance could result in a fine up to $500. Refer to s. 344.61-
SSN for commercial driver license privileges. 344.65 Wis. Stats. for full details.
COMMERCIAL DRIVER LICENSE APPLICANT ONLY
If applying for a HAZMAT endorsement (HME), complete Driver License Hazardous Materials Endorsement Application, form MV3735.
If applying for a school bus endorsement, complete School Bus or Alternative Vehicle License Information Request, form MV3740.
1. In the past 5 years, have you had a loss of YES NO 6. Is the vehicle you will be operating equipped YES NO
consciousness or muscle control caused by a   with air brakes?  
neurological condition, for example, seizure disorder?
7. D
 o you meet all the driver qualifications as required YES NO
by 49 CFR 391 to operate a commercial vehicle?  
2. In the past 2 years, have you taken insulin YES NO If not, see Motor Carrier Safety FAQs in the Wisconsin
to control a diabetic condition?   Commercial Driver’s Manual.

3. In the past 2 years, have you taken oral YES NO 8. S

 chool Bus, CDL Instructional Permit and YES NO
medication to control a diabetic condition?   New CDL Class/Endorsement Applicants Only.  
Is the vehicle in which you will take the commercial
YES NO driver license skills test representative of the type
4. Is your hearing impaired? (hard of hearing)
  of vehicle you will operate or intend to operate?
9. S
 chool Bus Applicants Only. YES NO
5. Have you held a valid operator's license in the YES NO H  ave you been convicted of an offense identified  
last 10 years from any jurisdiction (state) other   on School Bus or Alternative Vehicle License
than Wisconsin? Information Request, form MV3740 in Wisconsin
If yes, list all states: or any other jurisdiction? If yes, list date and place:

DRIVER LICENSE APPLICANT UNDER AGE 18 ONLY

Applicant Certification: I certify that in the past six months I have not Sponsor Certification: As the adult sponsor under s. 343.15 Wis. Stats.,
been ticketed for a moving violation that has or may result in a conviction. I accept liability and verify that the minor is not a habitual truant and meets the
I understand that falsifying this statement will result in the cancellation of educational requirements for licensure. If required for this application, I certify
my probationary license. Applicant Signature – REQUIRED. that the applicant has accumulated at least 50 hours of driving experience,
10 of which were at night.
Minor Name – Print

X
School Certification: I certify that this applicant is enrolled in approved Sponsor Name – Print Relationship to Applicant
behind-the-wheel training which begins no later than 60 days from date signed.
School ID Number School Name Sponsor Wisconsin DL/ID Number Sex Birth Date (mm/dd/yyyy)

X
Official WisDOT Test Results (line out if not used) (Sponsor Signature – Must be Witnessed by DMV Agent or Notarized)
Knowledge Test Highway Sign Test State of Wisconsin County of Subscribed and sworn to before me on this date
Pass    Fail  Pass    Fail 

X X
(Authorized School Official/Instructor Signature) (Date Signed) (DMV Authorized Agent or Notary Signature) (My Commission Expires)
DO NOT Use Notary Seal
WISCONSIN DRIVER LICENSE (DL) APPLICATION An unexpired Wisconsin
Wisconsin Department of Transportation MV3001 7/2021 Ch. 343 Wis. Stats. driver license is acceptable
photo ID for voting.
Clear Form Print
ALL APPLICANTS – Please Print (s. 5.02(6m) Wis. Stats.)
Social Security Number Applicant Name – First, Middle, Last Birth Date (mm/dd/yyyy)
6 2 9 - 9 4 - 1 6 7 1 Gabriela C. Yepes-Rossel 1 2 - 1 3 - 1 9 7 5
Residence Address – Street Apt # City State ZIP Code
514 E Washington St 2 Madison WI 53703
Mailing Address – ONLY IF DIFFERENT from Residence Apt # City State ZIP Code

Sex Race Eyes Hair Weight Height

Female Latina Brown Brown dark 136 5.5
Former Name (if changed since last license or ID card) Reason for Name Change
Marriage  Divorce  Other  List:

1. Do you wish to register to be an organ, tissue and eye donor? YES 

✔ 7. Will you donate $2 to organ, tissue and eye donation efforts? YES 
2. OPT OUT – Do you wish to have your name and address YES 
✔ 8. Do you need glasses or contact lenses for driving? YES NO
withheld from lists WisDOT sells?  
✔
3. I am a veteran registered with WDVA and wish to have my YES  9. Do you have any physical limitations which interfere with YES NO
veteran status indicated on my driver license. (DMV is your ability to perform the normal tasks associated with  
✔
required to verify your status with WDVA) operating a motor vehicle?
4. Has your license, ID card or operating privilege ever been YES NO If yes, have you successfully passed a road test with this YES NO
revoked, suspended, cancelled, disqualified or denied?  
✔ condition?  
If yes, list date and place: 10. In the past year have you had a loss of consciousness or YES NO
5. Have you been convicted of operating while intoxicated YES NO muscle control caused by any of the following conditions?  
✔
OUTSIDE of Wisconsin?  
✔ If yes, check condition(s) and list date(s):
If yes, give date and place: Traumatic Brain or Muscle or Seizure
Head Injury (2)  Nerve (2)  Disorder (4)  Heart (6) 
6. Do you hold a valid driver license/identification card from YES NO
another state/country? 
✔  Stroke (2)  Mental (3)  Diabetes (5)  Lung (7) 
If yes, list: Peru 11. Check ONLY ONE of the following three boxes.
Years of licensed driving experience in the United States, its I certify that I am a:
territories and Canada. List: Eight, in Texas  U.S. Citizen ✔ Temporary Visitor
 Permanent or Conditional Permanent Resident
I understand that I must surrender for cancellation any driver license or identification card previously issued by another state before I may be issued a
driver license or identification card in the State of Wisconsin. The State of Wisconsin will notify the other state that my driver license or identification card is
surrendered and cancelled, and that I have been issued a Wisconsin license or identification card. (ss. 343.11(1) and (2), and 343.50(1)(b) Wis. Stats.) I certify
that the information on this application is true under penalty of perjury and I am a resident of Wisconsin. (s. 343.14(5) Wis. Stats.)

X
(Applicant Signature) (Date)

OFFICE USE ONLY Reason for Reissue:

Date Processor ID Product Type

Wisconsin or Out-of-State License Number State Expiration Date  REAL ID  REGI  CLP  CYCI  SPRI  JUVI  MPDI
 PROB  RGLR  OCCL  SPRR  JUVP  NON
Hearing (CDL Only) Examiner ID Application Type
 ORG  RNW  DUP  REI  RSM  AMD  COA
Skill Test Score Highway Signs Knowledge Class(es) Issued Endorsements
A B C D M H N P S T F
Payment Amount
 Check  Cash  CC  Acct. $

(Processor Signature) (Processor ID)

VISION  Check if vision section completed by DMV Examiner

Temporal Field of Being duly licensed to practice
Visual Acuity Without RX With RX Vision In Degrees  Optometry  Medicine, in:  Wisconsin, or  Other
Name of State or Country
Right Eye 20/ 20/
I certify that the findings are correct
Left Eye 20/ 20/ and I examined this applicant on: (Exam Date)
Corrective lenses required while driving Color Perception
 YES  NO  Normal  Deficient
Progressive eye disease or cataracts If Yes, to Progressive eye disease or cataracts
X
 YES  NO  One Eye  Both Eyes (Eye Examiner Signature) (License #)