Driving Eligibility Hardship Request Form

Driving Eligibility Hardship Request Form
*The parent or legal guardian must complete and sign this form*
Cases of hardship must reflect circumstances that are beyond the control of the student, his or her parents, or the school.
The specific hardship circumstances are divided into three categories. For specific examples, please read the back of this
form.
Please check appropriate hardship consideration:
q
q
q
#1 Medical Considerations
#2 Work Related Considerations
Other Considerations – Please specify:
Name of Student:
Date of Birth:
School:
Name of Parent or Legal Guardian:
Mailing Address of Parent/Legal Guardian:
(Street address, including apt #, etc.)
(City, State, Zip Code)
Phone numbers for Parent/Legal Guardian:
Work:
Home:
To be considered for a hardship, all information on this form must be completed. Support documents (a letter from a
doctor, etc.) will be required to determine whether your request will be approved. Briefly explain the circumstances of
your hardship request. Include any documents/attachments.
Signature of Parent/Legal Guardian
Date
Please submit this form by to:
Wake County Public School System
CASS Project Manager – Dropout Prevention
Crossroads II
110 Corning Road
Cary, North Carolina 27511
or
FAX (919) 365-0016
Revised 09/14/2015
Inadequate Progress
Page 1 of 2
EXAMPLES OF HARDSHIP
and Proof Required to Support Hardship
MEDICAL CONSIDERATIONS:
For the student - A note from a doctor must be submitted with the reasons why the
student missed school and why the student's illness/accident caused the student to begin
failing classes. Along with the doctor's note, documentation is required showing that the
student was making adequate progress before the illness, accident, etc. This should be in
the form of statements from teachers, an interim report card, etc. If the student was
capable of making up work and failed to do so, causing them to fail classes, a hardship
will not be granted.
For the parent - A note from a doctor must be submitted with the reasons why the parent
is unable to drive.
WORK-RELATED CONSIDERATIONS:
For the student - there is no hardship consideration given to a student based solely on the
student's desire to earn additional income or to save for college.
For the family - a copy of the student's earnings statement must be submitted with the
hardship. A written statement from the parent stating the parents' yearly income and a
list of household bills with the average monthly cost of each is also required. We DO
NOT require an official earnings statement from the parents, simply a written statement.
The WCPSS does reserve the right to confirm the accuracy of any documentation before
granting a hardship. For this consideration, the student must still show that there is no
other means of transportation to and from his/her job. If there is public transportation,
the hardship will be denied.
OTHER CONSIDERATIONS:
This is for unusual circumstances not covered by the first two categories and will be
reviewed on an as-needed basis.
Supporting Documentation
Please note that support documents will be required to prove hardship cases.
HARDSHIP REQUEST FORMS THAT DO NOT HAVE SUPPORT DOCUMENTATION WILL NOT BE
REVIEWED.
Revised 09/14/2015
Inadequate Progress
Page 2 of 2