Student Registration 24/25

Student Registration
Destiny Truck Driving Academy

150 Driving Park Rd. Wellston, Ohio 45692 Ph: 740-721-4313
Name*

First NameLast Name
Date Of Birth

MonthDayYear
Date
Social Security Number

#########
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / County

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Payment Method

CashCashier's Check/ Business Check/ Money OrderCredit CardEmployer PayingAgency (Please fill out agency information below)
Ohio Means Jobs County: blanks Caseworker: blank
Select Program

Class A $5300Class B $3000Passenger Endorsement Add On $1250Hazmat $500
Start Date

MonthDayYear
Date
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Signature

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Student Registration