Behind-the-Wheel Student Application

Student Name *

First Name Middle Name Last Name Suffix

Sex *

Birth Date *

Month Day Year

Student Cell Phone *

Student Email *

example@example.com

Name of High School (if attending HS)

School Dismissal Time

Hour Minutes

AM/PM Option

Student Home Address *

Street Address

Street Address Line 2

City

Postal / Zip Code

Parent or Guardian Name (under age 18)

First Name Last Name

Parent or Guardian Email (under age 18)

example@example.com

Parent or Guardian Cell Phone (under age 18)

Relationship to Student

Which Class Are You Applying For? *

Teen Behind-the-Wheel ---- 7 days of driving for 50 minutes and a road skills test to earn a provisional driver's license. These are NOT driving lessons. You have to already be an experience driver. This is an assessment course of your driving skills.

$ 270.00

Adult Behind-the-Wheel: Pro ---- 7 days of driving for 50 minutes and a road skills test to earn an adult waiver for the issuance of a driver's license from the DMV. These are NOT driving lessons. You have to already be an experienced driver. This is an assessment course of your driving skills.

$ 300.00

Adult Behind-the-Wheel: Rookie ---- 7 days of driving for 50 minutes and a road skills test to earn an adult waiver for the issuance of a driver's license from the DMV. We CANNOT guarantee that you will be ready for the road test or pass the road test after the completion of these driving periods. We HIGHLY recommend practicing with friends and family to help build and strengthen your driving skills.

$ 450.00

Adult Behind-the-Wheel: Rookie PLUS ---- 7 days of behind-the-wheel + 3 days of driving lessons for a total of 10 driving periods (50 minutes each) and a road skills test to earn a driver's license from DMV. We CANNOT guarantee that you will be ready for the road test or pass the road test after the completion of these driving periods. We HIGHLY recommend practicing with friends and family to help build and strengthen the driving skills you learn.

$ 600.00

Behind-the-Wheel Re-examination ---- This is the requirement for adults and teens who fail the DMV road skills test three times. The class is 7 days of driving for 50 minutes and you return to the DMV to retake the road test a fourth time.

$ 500.00

Total

$ 0.00

How Do You Wish to Pay? *

I will pay by credit card online via a Square Invoice sent by email. I will pay by cash or money order dropped off to the office. To make arrangements for drop off with our office call 757-926-5956. An organization will pay my fees by check dropped off to the office. Please have the organization sponsoring you to call us at 757-926-5956 to make drop off arrangements.

Do You Have a Virginia Learner's Permit? *

Yes No - You do not meet the state requirements and if you submit this application it will be rejected with no notice.

Learner's Permit Issue Date *

Date

Adult Applicants Understand They Must Meet ALL of the Guidelines Below To Qualify for an Adult Waiver. *

I have a Virginia learner's permit. I have completed a 36-period Virginia driver education class or I am currently enrolled in driver education. I have NEVER held a driver's license. This includes a driver's license issued by any state, U.S. territory, or foreign country. I have NOT failed the DMV final road skills test three times. I have NEVER had my driving privilege prohibited, suspended, or revoked by any court or the DMV.

Have You Completed Driver Education in a Classroom or Online? *

Yes No - However, I am currently enrolled in Top Notch Driving Schools online course and qualify to take both driver education and behind-the-wheel simultaneously No - You do not meet the state requirements and if you submit this application it will be rejected with no notice.

Name of the School Where You Completed Driver Education *

Driver Education Course Completion Date *

Date

How Many Hours of On The Road Driving Practice Have You Completed So Far? *

NOTE: If under age 18, then you must have at least 30 hours completed to begin this course and 45 hours completed is required before the provisional driver's license will be issued.

Select the Types of Roads You Have Experience With *

None Parking Lot Residential Streets (15-25 mph) City Streets (35-45 mph) Interstate (55-65 mph) Bridge Tunnel

Select the Form You Will be Submitting as Proof of Your Experience *

Under age 18 - Driving Log with Parent/Mentor Signature Age 18 or older - CSMA 19 with Skills Checked and Signed by a Licensed Driver

Desired Start Date *

NOTE: Every effort is made to begin the driving course on the date desired as entered BUT scheduling is based on the order that applications are received as well as student/instructor availability during daylight hours.

Pick Days for Driving *

Monday Tuesday Wednesday Thursday Friday Saturday

Provide the Time Available for Each Day Selected *

NOTE: We do not make a habit of driving after daylight hours. However, we can schedule a couple of 5:00 pm or 6:00 pm appointments if absolutely necessary and the instructor is available.

Questions or Comments

How Did You Find Out About Our School? *

Only click the submit button one time. Clicking the button twice or more will result in duplicate submissions to our inbox.