CDIC Course Registration

1
Name* This field is required.
First Name
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.
Drag and drop files here
Select files to upload
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.
Cancelof
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
1 of 3
10
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 +)
11
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.
12
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. Our next two sessions are scheduled to begin on Monday, November 16th and Monday, December 14th at 4 pm. 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 $130; 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.
14
Course Payment
prevnext( X )
My Bag
0
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
8-Hour Driver Improvement
$55+Remove
Back
3-Test DMV Failure / Learner's Permit Prep (Ages 18 and Over)
$130+Remove
Back
Driver's Ed Classroom / 3-Test DMV Failure (Under 18)
$160+Remove
Back
Enter Coupon
Total cost $0.00
Course Payment
loading smart payment buttons...
The payment is ready! It will be completed once you submit the form.
15
Should be Empty: