• I am requesting that the court place me on supervision for the enclosed traffic violation. It does not require me to appear in court.
• I understand that my supervision will last 180 days from the date the PLEA is recorded at the court and it requires me to receive no other convictions for additional traffic violations during this time.
• I have not been placed on court supervision (either by court appointment or by participating in this or any other Traffic Safety Program) for any other traffic violation issued within 12 months (365 days) of the violation. If you are under 21, you are required to take the class in person. If extenuating circumstances exist, call the Traffic Safety Program office.
• I understand that I am PLEADING GUILTY to the charge on this ticket, I WAIVE my right to a hearing by the court or jury and request court supervision.
• I agree to complete the Traffic Safety Program within 160 days from the date of the violation.
• I understand my supervision will be revoked and my guilty plea will be used to enter a conviction if:

1. I am found to be ineligible.
2. I don't complete the class within 160 days from the date of the violation.
3. I receive another traffic violation within my supervision period.
4. I fail to return my certificate of completion for attendance of a non-SVCC/RVC traffic safety school to the Traffic Safety Program office within the specified 160 days.