Form DE-264 template
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Certification of Cognitive Disorder for Driver's License Identifier (DE-264)
The DE-264 document from July 2017 is an application form for a cognitive disorder identification card for a Kansas driver's license. The applicant must be a Kansas resident and the application must be signed by a certified healing arts professional, such as a doctor of medicine, osteopathy, chiropractic, podiatric medicine, optometrist, physician assistant, or advanced registered nurse practitioner. The document also includes instructions for mailing the application to a specific address and details about penalties for misuse of the card.
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