Nichols Driving School (MA)

Please fill out the form below and we will get back to you as soon as possible.
STUDENT INFORMATION
Full Legal Name (Exactly as shown on your Massachusetts Learner's Permit or Driver's License)

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Massachusetts Permit or Driver's License Number
Permit/License Issue Date:

MonthDayYear
Date
Permit/License Expiration Date

MonthDayYear
Date
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Is this the best number to reach you?
Do you have a valid Massachusetts Learner Permit or Drivers License?
If no, please provide the preferred phone number:
HOME ADDRESS
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
LICENSE / PERMIT STATUS
Do you currently have:
If you do NOT have a Massachusetts Learner's Permit, when do you expect to obtain one?
DRIVING EXPERIENCE
Approximately how many total hours have you driven?
Which driving environments have you practiced in?(Check all that apply)
How comfortable are you driving?
Which skills would you like to improve?(Check all that apply)

Other
What are your biggest concerns or fears while driving?
LESSON GOALS
What are you hoping to accomplish?

Other
LESSON PACKAGE
Which lesson package interests you?
ROAD TEST INFORMATION
Do you need your Massachusetts Driver's License?
Are you interested in Road Test Sponsorship through Nichols Driving School?
Have you taken a Massachusetts Road Test before?
If YES...
How many times?
Approximate date(s):
What caused you to fail, or what feedback did the examiner provide?
Do you currently have a Road Test scheduled?
If YES...
Road Test Date:

MonthDayYear
Date
Time:

Hour Minutes

AM/PM Option
RMV Location:
PREVIOUS DRIVING SCHOOL EXPERIENCE
Have you ever enrolled with another Massachusetts driving school?
If YES, please provide the driving school name.
(We ask this because Massachusetts RMV regulations require student records to be transferred before we can provide certain services.)
SCHEDULING
What days work best for driving lessons?
Preferred lesson times:
Preferred lesson location (if applicable):
EMERGENCY CONTACT (Optional)
Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
ADDITIONAL INFORMATION
Type a question
ACKNOWLEDGMENT

I certify that all information provided is accurate. I understand that lesson scheduling and road test services may depend on permit eligibility, RMV requirements, instructor availability, and completion of any required paperwork.
Initial:
Date:

MonthDayYear
If you have a permit/license what is your driving experience? (parking lots, some on-road driving, highways, etc.)
If you have had any driving experience, how many hours of driving would you say you have had total?
What type of driving lessons are you looking for? (lessons for beginners, refresher lessons, road test prep-lessons)
Which Adult driving package are you interested in?
If you require a license are you interested in a road test sponsorship with our driving school?
Have you taken a road test before?
If you have taken a road test before, how long ago was that road test? And what did you fail on?
Do you currently have a scheduled road test? If YES, what location? And when is your road test scheduled for?
Have you conducted business with any other driving school in Massachusetts? If YES, What is the name of the Driving School? (We need this information in order to transfer you to our driving school before we can provide services)
Additional Comments
Should be Empty:

STUDENT INFORMATION

HOME ADDRESS

LICENSE / PERMIT STATUS

DRIVING EXPERIENCE

LESSON GOALS

LESSON PACKAGE

ROAD TEST INFORMATION

PREVIOUS DRIVING SCHOOL EXPERIENCE

SCHEDULING

EMERGENCY CONTACT (Optional)

ADDITIONAL INFORMATION

ACKNOWLEDGMENT