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2. 
3. Instructions:

   You must complete this request and submit all documentation required. It is your responsibility to follow up with the court at 817-985-2140 to verify receipt of your request. After your request is reviewed, the court will mail and email you a notice of your agreement if you meet the eligibility terms. If you DO NOT meet the eligibility terms, court staff will contact you. Please call prior to submitting your request to verify if you’re eligible. By submitting the request, you are declaring to the Court that the information provided is correct. False statements to the Court will be considered perjury and referred to the Tarrant County District Attorney's office for prosecution.

   Please note: Not all violations are approved for Driving Safety. 

5. Citation Number: *
6. Violation:*
8. First Name*
9. Last Name*
11. Date of Birth:*

    MM-DD-YYYY

13. Address*
15. City*
16. State*
17. Zip*
19. Cell/Primary Phone*
20. Alternate Phone
22. Email*
24. Requirements

    I, the Defendant in the above-entitled cause, do hereby enter my plea of No Contest, waive my right to a jury trial and request a Driver Safety Course.  I understand that I can only make this written request on or before my appearance date and I must meet all eligibility requirements in order for this request to be granted.  I further understand that I must receive the Court's permission before taking the Course.

    I swear that the following statements are true:

    • I  waive discovery pursuant to Article 39.14, C.C.P., waive my right to a trial by jury, and enter a plea of NO CONTEST .
    • I am providing the Court with a photocopy of my valid Texas driver's license/permit, which is not revoked/suspended, and is NOT a Commercial Driver's License; and valid proof of Texas minimum liability insurance
    • I am prepared to make the required PAYMENT ($144 in regular zone or $169 in a school zone) of the court costs and administrative fee AT THE TIME THAT MY REQUEST IS GRANTED AND I UNDERSTAND A PAYMENT PLAN WILL NOT BE GRANTED to give me more time to make this payment.
    • I understand that I am not eligible if I currently hold a Commercial Driver's License (CDL) or I held a Commercial Driver's License (CDL) at the time of this offense.
    • I have not taken a Driver Safety Course for dismissal of a ticket within the one (1) year period prior to the offense date in this matter.
    • I am not currently taking nor have I taken, a Driver Safety Course for another offense in any Court in the State of Texas that is not yet reflected on my driving record.
    • I was charged with a traffic offense under the State of Texas Transportation Code. 
    • I was not charged with exceeding the posted speed limit in excess of 24 miles per hour; and I was not charged with a serious traffic offense, which includes traffic offenses committed in a Construction Zone with workers present.
    • If the Court grants this request, I understand that I will have 90 (ninety) days to order a Certified Copy of my Driving Record as maintained by the Texas Department of Public Safety and successfully complete a Driver Safety Course approved by the Texas Department of Licensing and Regulation. If I was charged with an offense while operating a motorcycle, I must complete a course under the motorcycle operator training and safety program approved by the state agency under Chapter 662, TRC.
    • If I comply with the court order granting the taking of a driving safety/motorcycle operator training course and submit all the required evidence as ordered, the Court will dismiss my case and report to the Texas Department of Public Safety the date that I completed my course for inclusion on my driving record.
    • If I fail to submit all the evidence required by the Court, I will be notified of a show cause hearing and be required to appear before the Court to show cause why I did not present the required evidence of course completion.
    • Failure to appear at the show cause hearing will result in a final adjudication being entered against me and a Capias Pro Fine warrant may be issued for my; arrest and I may also be denied renewal of my driver's license until I have paid or disposed of my case.

    1. I swear and affirm I have read and understood the statement above.
26. Plea-Select ONLY one *

    By entering a plea I, the Defendant, do hereby waive discovery pursuant to Article 39.14, C.C.P., waive my right to trial and enter my plea of (please check a box below):

    1. GUILTY
    2. NO CONTEST
28. AFFIDAVIT FOR DRIVING SAFETY COURSE (Art 45.0511(c)(3), CCP)*

    I state under oath that on the date of my request for a driving safety course/motorcycle operator training course in the above numbered cause; that I was not taking such a course nor, had I completed one within the 12 months preceding the date of my current offense that is not shown on my driving record as maintained by the Texas Department of Public Safety.

    1. I swear and affirm the above statement is true.
32. Proof of Driver's License*

    Upload proof of Valid TEXAS Driver's License.

33. Proof of Texas minimum liability insurance.*

    Upload picture of your current Insurance Card with your name on it 

35. * The court may require further information to verify your identity. 

36. 
38. SIGNATURE*

    By typing my name in the box above, I verify that all information provided on this application is true and correct.

Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field