CDIC Course Registration

1
Name* This field is required.
First Name
(FULL) Middle Name
Last Name
Suffix
2
Birth Date* This field is required.
Month
Day
Year
3
Phone Number* This field is required.
Area Code
Phone Number
4
Email
example@example.com
5
DMV Customer or Driver's License Number* This field is required.Please enter your DMV customer number. Note: If you are unaware of your customer number, you may find it DMV's website or by contacting DMV directly.
6
Zip Code* This field is required.
7
Photo IdentificationUpload a clear copy of your DMV-issued Driver's License, Learner's Permit, or ID. Note: If you have not obtained a form of identification or it has been removed by the court or DMV, please upload a copy of the DMV paperwork.
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Max. file size: 10.6MB
This section is not required and may be skipped at this time but an ID must be provided on the day of class in order to verify identity.
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8
How Did You Hear About CDIC?* This field is required.
Search Engine (Google, etc.)
Friend / Family Recommendation
Facebook/Instagram
Passing by Laburnum /Visiting Shopping Center
Online Ad / Flyer
9
Do any of the below questions apply to you?* This field is required.
Yes
No
Received a positive test for the virus that causes COVID-19 disease within the past 10 days?
Have a cough, shortness of breath, sore throat, muscle aches, fever, or chills that cannot be attributed to another health condition?
Have a fever (100.4°F or higher) or a sense of having a fever?
Received a positive test for the virus that causes COVID-19 disease within the past 10 days?
Have a cough, shortness of breath, sore throat, muscle aches, fever, or chills that cannot be attributed to another health condition?
Have a fever (100.4°F or higher) or a sense of having a fever?
Yes
No
Yes
No
Yes
No
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Select Reason for Attendance* This field is required.
8-Hour Driver Improvement - Court Ordered
8-Hour Driver Improvement - DMV Ordered (Compliance Summary Request)
8-Hour Driver Improvement - Volunteer (Positive Points, Prior to Court or Insurance)
Driver's Education Classroom / Learner's Permit Preparation (Under Age 18)
3-Test DMV Failure / Learner's Permit Preparation (Ages 18 +)
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Driver Improvement (Court and DMV-Approved)* This field is required.For those who have been ordered by the court, DMV, or are volunteering for positive points on their driving record/insurance company. At the end of class, attendees will receive a completion certification. The cost of this class is $55; which can be prepaid at the end of this registration form or in person. Note: While we will accept walk-ins, paid online registrations will receive priority until the class capacity has been reached. Doors will open promptly at 8:30 am. FACE MASKS ARE ALSO REQUIRED.
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36-Driver's Education Classroom Instruction / Re-Examination, Under Age 18 (3-Test DMV Failure)* This field is required.For teenagers who are either in need of Driver's Education classroom training and/or those who have either failed the VA Learner's Permit test three times or need assistance with learning the materials necessary to pass the written test. Attendees should bring a pen/pencil and paper. FACE MASKS ARE ALSO REQUIRED. The cost of this class is $160; which can be prepaid at the end of this registration form or on the day of class. Paid online registrations will receive priority until class capacity has been reached.
13
8-Hour Driver's Manual, Ages 18+ (3-Test DMV Failure)* This field is required.This course assists adults (ages 18+) with the content needed to pass the written test at DMV. Upon class completion, attendees who have failed the test at least three times will receive a certificate to present to the DMV; which allows them the ability to test up to one additional year. Attendees are encouraged to bring a pen/pencil and paper. Class is scheduled from 8:30 am to 4:30 pm, to include a lunch break. FACE MASKS ARE ALSO REQUIRED. Note: The cost of this class is $120; which can be prepaid at the end of this registration form or in person. Also, while we will accept walk-ins, paid online registrations will receive priority until the class capacity has been reached. Doors will open promptly at 8:30 am.
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ORDER SUMMARY
8-Hour Driver Improvement
$55+Remove
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3-Test DMV Failure / Learner's Permit Prep (Ages 18 and Over)
$120+Remove
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Driver's Ed Classroom / 3-Test DMV Failure (Under 18)
$160+Remove
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
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Payment Methods
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