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Form	
  DL-­‐4A	
   09/2011	
  
1	
  of	
  2	
  
	
  
	
  
	
  
	
  
	
  
	
  
	
  
	
  
	
  
	
  
	
  
DRIVING	
  LOG	
  TO	
  ADVANCE	
  TO	
  N.C.	
  LEVEL	
  2	
  LIMITED	
  PROVISIONAL	
  DRIVER	
  LICENSE	
  
	
  
REQUIREMENTS:	
  
·∙	
  	
  	
  Complete	
  a	
  minimum	
  of	
  60	
  hours	
  of	
  driving.	
  
·∙	
  	
  	
  No	
  more	
  than	
  10	
  hours	
  per	
  week	
  may	
  count	
  toward	
  the	
  60	
  hours.	
  
·∙	
  	
  	
  At	
  least	
  10	
  of	
  the	
  60	
  hours	
  must	
  be	
  at	
  night.	
  
·∙	
  	
  	
  The	
  log	
  must	
  be	
  signed	
  by	
  a	
  supervising	
  driver	
  and	
  turned	
  in	
  to	
  DMV	
  upon	
  application	
  for	
  the	
  Level	
  2	
  driver	
  license.	
  	
  
·∙	
  	
  	
  A	
  supervising	
  driver	
  must	
  be	
  a	
  parent,	
  grandparent,	
  or	
  guardian	
  of	
  the	
  permit	
  holder	
  or	
  a	
  responsible	
  person	
  	
  
approved	
  by	
  the	
  parent	
  or	
  guardian,	
  and	
  must	
  be	
  a	
  licensed	
  driver	
  who	
  has	
  been	
  licensed	
  for	
  at	
  least	
  five	
  years.	
  
	
  
	
  
Customer	
  Name:	
  	
   	
  	
  Customer’s	
  DL	
  Number:	
  	
   	
  
(Please	
  Print	
  Name)	
  
	
  
I	
  	
  	
  	
   ,	
  do	
  certify	
  that	
  the	
  information	
  on	
  this	
  form	
  is	
  true	
  and	
  accurate	
  and	
  is	
  
(Print	
  Supervising	
  Driver’s	
  Name)	
  
	
  
in	
  accordance	
  with	
  N.C.	
  G.S.	
  20-­‐11(d),	
  	
  	
   	
   	
  	
   /	
  	
   /	
  	
   	
  
(Supervising	
  Driver’s	
  Signature)	
   (Date)	
  
	
  
Notice:	
  If	
  the	
  Division	
  has	
  cause	
  to	
  believe	
  that	
  a	
  driving	
  log	
  has	
  been	
  falsified,	
  the	
  limited	
  learner’s	
  permit	
  holder	
  shall	
  be	
  
required	
  to	
  complete	
  a	
  new	
  driving	
  log	
  with	
  the	
  same	
  requirements	
  and	
  shall	
  not	
  be	
  eligible	
  to	
  obtain	
  a	
  limited	
  provisional	
  license	
  
for	
  six	
  months.	
  	
  
	
  
DATE	
  
	
  
TIME	
  OF	
  
DAY	
  
	
  
TIME	
  OF	
  	
  
NIGHT	
  
AMOUNT	
  OF	
  
DRIVING	
  TIME	
  
(E.G.	
  #	
  HOURS)	
  
	
  
SUPERVISING	
  DRIVER’S	
  PRINTED	
  NAME	
  
SUPERVISING	
  
DRIVER’S	
  DL	
  	
  
(Number	
  and	
  State)	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
  
Form	
  DL-­‐4A	
   09/2011	
  
2	
  of	
  2	
  
	
  
	
  
	
  
	
  
DATE	
  
	
  
TIME	
  OF	
  
DAY	
  
	
  
TIME	
  OF	
  	
  
NIGHT	
  
AMOUNT	
  OF	
  
DRIVING	
  TIME	
  
(E.G.	
  #	
  HOURS)	
  
	
  
SUPERVISING	
  DRIVER’S	
  PRINTED	
  NAME	
  
SUPERVISING	
  
DRIVER’S	
  DL	
  	
  
(Number	
  and	
  State)	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  
	
   	
   	
   	
   	
   	
  	
  
	
  
	
  
Total Day Hours Driven: _ Total Night Hours Driven: _ Grand Total:______________

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NC Driving Log for Level 2 Provisional License

  • 1. Form  DL-­‐4A   09/2011   1  of  2                         DRIVING  LOG  TO  ADVANCE  TO  N.C.  LEVEL  2  LIMITED  PROVISIONAL  DRIVER  LICENSE     REQUIREMENTS:   ·∙      Complete  a  minimum  of  60  hours  of  driving.   ·∙      No  more  than  10  hours  per  week  may  count  toward  the  60  hours.   ·∙      At  least  10  of  the  60  hours  must  be  at  night.   ·∙      The  log  must  be  signed  by  a  supervising  driver  and  turned  in  to  DMV  upon  application  for  the  Level  2  driver  license.     ·∙      A  supervising  driver  must  be  a  parent,  grandparent,  or  guardian  of  the  permit  holder  or  a  responsible  person     approved  by  the  parent  or  guardian,  and  must  be  a  licensed  driver  who  has  been  licensed  for  at  least  five  years.       Customer  Name:        Customer’s  DL  Number:       (Please  Print  Name)     I         ,  do  certify  that  the  information  on  this  form  is  true  and  accurate  and  is   (Print  Supervising  Driver’s  Name)     in  accordance  with  N.C.  G.S.  20-­‐11(d),             /     /       (Supervising  Driver’s  Signature)   (Date)     Notice:  If  the  Division  has  cause  to  believe  that  a  driving  log  has  been  falsified,  the  limited  learner’s  permit  holder  shall  be   required  to  complete  a  new  driving  log  with  the  same  requirements  and  shall  not  be  eligible  to  obtain  a  limited  provisional  license   for  six  months.       DATE     TIME  OF   DAY     TIME  OF     NIGHT   AMOUNT  OF   DRIVING  TIME   (E.G.  #  HOURS)     SUPERVISING  DRIVER’S  PRINTED  NAME   SUPERVISING   DRIVER’S  DL     (Number  and  State)                                                                                                                                                                                                                                                    
  • 2. Form  DL-­‐4A   09/2011   2  of  2           DATE     TIME  OF   DAY     TIME  OF     NIGHT   AMOUNT  OF   DRIVING  TIME   (E.G.  #  HOURS)     SUPERVISING  DRIVER’S  PRINTED  NAME   SUPERVISING   DRIVER’S  DL     (Number  and  State)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Total Day Hours Driven: _ Total Night Hours Driven: _ Grand Total:______________