The official Ohio paperwork is 50 hours affidavit (notarized). This sheet is not an official form: it is a dated
record you can keep as you go and copy onto, or attach to, whatever Ohio asks for.
Official source.
- The state certification is sworn before a notary or examiner; this sheet is your supporting record.
Learner name
Permit / licence number
Supervising adult
Adult licence number
| Date | Start | End | Total min | Night min | Road / weather | Adult initials |
|---|---|---|---|---|---|---|
| Page totals | ||||||
I confirm that the drives listed above took place as recorded and that I supervised them.
Supervising adult signature
Date
Learner signature
Date