Thumb CDL, LLC

Name

First NameMiddle NameLast Name

Date of Birth

Date

Age

Address

Street Address

Street Address Line 2

City

Postal / Zip Code

Drivers License #

L202123187229

Cell Phone Number

Please enter a valid phone number.

Home Phone Number

Please enter a valid phone number.

Email*

example@example.com

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone Number

Please enter a valid phone number.

Does the student require any special accommodations to participate in the classroom phase (ex. Test being read,interpreter, etc.)?

Yesno

If Yes, please explain

Does the student require any special accommodations to participate in the BTW phase (ex. Adaptive devices, interpreter,etc.)?

yesNo

If Yes, please explain

Are there any medical conditions that would pose a concern with the student’s BTW instruction (ex. epilepsy, colorblindness, etc.)?

YesNo

If Yes, please explain

Is the student taking any medications that may affect his/her ability to drive a motor vehicle safely?

YesNO

If Yes, please explain

In the last 6 months, has the student had a fainting spell, blackout, seizure, or other uncontrolled loss of consciousness?

YesNo

In the last 6 months, has the student had a physical or mental condition which would affect his/her ability to drive a motorvehicle safely?

YesNo

Is the student’s visual acuity at least 20/40 corrected?

YesNo

Date*

Date

Hour MinutesAM/PM Option

Provider Name

Title

How is your training being provided

AM / PM

Semester

Class ID

Preferred Range Location

What Classification Of License do you want?*

Type of class you would like?

please select online unless you have been given a class day and time

What course would you like?

Classroom Hours

Range Hours

Observation Hours

Roadway

Course Cost

in-person class day

Class time

class room weeks

class room name

COURSE PROVISIONS

Thumb CDL, LLC will provide a minimum of ____ hours classroom instruction, ____ hours of range skills, ____ hours of driving observation, and ____ hours of
public road instruction for CDL Training. This course is Entry Level Driver Training (ELDT) compliant and you must score an 80% or higher to pass. Thumb CDL,LLC
will conduct the behind-the-wheel instruction in a tractor-trailer that is fully insured to cover each student enrolled in the program. Students must obtain a
Commercial License Permit (CLP) by achieving a score of 80% or higher on the State of Michigan “Knowledge” test. Qualified applicants may receive assistance
from a funding institution (i.e. Michigan Works, ISD for ISD students, employer) for up to course cost. Any balance after assistance must be paid in full, by the
student, before the 3rd party test can be taken. Classes will normally run during school hours for ISD students (if school is cancelled due to weather, classroom/
drives will also be cancelled) for____ weeks for a total of ____ hours.
IN PERSON CLASS DATES:_______________ TIMES:_______________ Class Location: ______________ Type of Class:___________
ONLINE CLASS:________________________

TERMS

1. Prior to beginning the class, Thumb CDL,LLC must have received authorization from the funding institution.
2. Students must present a current US DOT physical examination card and drug screen at the time the course begins.
3. Total fee for this course: _____________.
4. Payment methods accepted: credit card (3.55% additional convenience fee will be added to the total amount when using a credit card), cash, money order,
or checks. Thumb CDL, LLC will not accept postdated checks. Payment plans are available, if needed, and must be pre-approved prior to the beginning of
class.
5. Student attendance is required for all class times. In the event of an emergency, our instructor(s) need to be notified as soon as possible. Missed classroom
sessions must be made up on the student’s time (evenings/weekends). Students will be given materials and a quiz that must be completed with an 80% or
higher.
6. There is no charge for any materials or supplies provided during the course, however, students will be responsible for the following fees: DOT physical, Drug
Screen, Motor Vehicle Report (MVR) to determine eligibility, Commercial Learner’s Permit (CLP), and All Road Test Fees.
7. The student will be charged $75.00 for text books not returned upon completion of the class.
8. The use of Thumb CDL, LLC’s tractor-trailer for 3rd party testing is included in tuition cost. However, if a student fails the road test, they will be responsible
for the additional road testing fee as well as truck rental. Truck rental may be split amongst multiple students if applicable. Financial help may be available
for these costs if needed.
9. Students are expected to complete the course in the allotted amount of time for that specific course (ex. CDL A 160 would be 160 hours completed). If the
student cannot complete by the end of the course, they will have the option to purchase more time at a rate of $125.00/hour up to 10 hours. If the student
chooses not to purchase extra time or cannot complete within the extra time they have purchased, they will be removed from the program.
10. Students will be charged $50.00 for requested BTW appointments that they fail to show up for unless they give no less than 24 hour notice.
11. For Self-Pay Students: The total cost of the course is payable at the first classroom instruction date. Payment plans must be reviewed and approved prior to
the first day of class.
12. For Michigan Works Students: Students are responsible to follow up with their funding institution to receive qualification for funding. If the student doesn’t
follow through with funding approval, they are responsible for the full amount of the course.
13. The student MUST BE 18 years old to operate a Commercial Motor Vehicle (CMV).

REQUIREMENTS TO PASS THE COURSE
1. An 80% minimum score is required to pass this course (before moving onto the 3rd party state examination).
2. It is the student’s responsibility to learn the curriculum provided. All homework, quizzes, and assessment tests must be completed to pass this
course. Thumb CDL, LLC does not guarantee that each student will pass this class.

REFUND POLICY
NO REFUNDS will be offered after day 2 of class.

Notice - This provider is required to be certified by the Secretary of State. If you have any complaint that cannot be
settled with the provider, please complete the DES-P11 Statement of Complaint form found on the Department of
State website; Michigan.gov/DriverEd. Completion of driver education instruction does not guarantee qualification
for a driver license.

The blanks will be filled when you submit, based on your selections

I agree to the above Course provisions, Terms, Requirements and Refund Policy*

Yes

Signature*

Clear

Parent or legal guardian Signature( if 17 year of age)

Clear

CDL Contract