Minds Matter DMV Check Form

Please enter your information exactly as it appears on your driver's license:

Minds Matter Chapter

First Name

Middle Name

Last Name

Date of Birth

Gender on License

Email Address

Phone Number

Street Address Line 1

Street Address Line 2

City

State

Zip Code

Month and year you began living at your listed address

Driver's License Number

State of Driver's License

Driver's License Expiration Date

Please upload proof of insurance

By checking this box you agree that you are consenting to a DMV Records Check by Minds Matter.

By checking this box you confirm that Minds Matter has made available to you the FCRA Summary of Rights for Background checks (Available here: http://bit.ly/DMVConsent)

You are entitled to receive a copy of your DMV record report. Please check this box if you would like to receive the report, which will be sent via email.

Contact Information