Exhibit A
MOTOR VEHICLE REPORT REQUEST
THE UNIVERSITY OF TEXAS AT DALLAS
DEPARTMENT:
MAIL STATION:
**Requestors must hold a valid driver’s license from the State of Texas in order to drive a UTD vehicle**
FULL NAME
(Last Name First)
TEXAS
LICENSE
NUMBER
UTD ID
DATE OF
BIRTH
DRIVING
RATING
DATE/LAST
TRN/COUNS.
Privacy Statement
Disclosure of your Texas Driver’s License number, UTD ID and date of birth are requested as part of the Police
Department requirements for obtaining your Motor Vehicle Report. Your TX Driver’s License number, UTD
ID and date of birth are also used by the Environmental Health and Safety Department as a way to identify you
within The University of Texas at Dallas Authorized Driver’s System. Further disclosure of this information
will be governed by the Public Information Act (Chapter 552 of the Texas Government Code).