Skip to main content

Back to Bentley

The university will return to campus this fall. Read our plan at www.bentley.edu/BacktoBentley 

Nonresident Student Information

Residential Address while attending school
This must be 17 characters long.
Vehicle Owner Information

This vehicle can only be operated during such time as the owner thereof maintains in full force a policy covering all of the provisions in M.G.L., Ch. 90, Sec 3. Coverage sufficient to allow a “Yes” to both a) and b) is required.

a.) Does this policy provide at least $20,000 coverage for injury or death to one person and $40,000 coverage for injury or death to more than one person while the vehicle is being operated on the ways of Massachusetts?
b.) Does this policy provide indemnity for any operator of this vehicle while being operated with the express or implied consent of the owner?
DID YOU RECEIVE A WRITTEN WARNING FROM YOUR SCHOOL INDICATING A PENALTY OF UP TO $200.00 FOR YOUR FAILURE TO FILE THE COMPLETED NONRESIDENT DRIVER STATEMENT WITH THE POLICE DEPARTMENT?

I HEREBY CERTIFY UNDER THE PENALTIES OF PERJURY THAT THE ABOVE INFORMATION IN EACH OF THE THREE PARTS IS TRUE AND COMPLETE. I ALSO UNDERSTAND THAT A COPY OF THIS FILING WILL BE PROVIDED TO THE LOCAL ASSESSOR WHERE I RESIDE.

Please note you have not submitted this form yet. Please print out this page and then click submit at the bottom of this page. After submitting please bring the printed out document, signed, to the University Police.