Meathead CDL School Enrollment form

Per federal requirement FMCSA 391.11 (2) student must be able to read and speak the English language sufficiently to converse with the general public, to understand highway traffic signs and signals, to respond to official inquiries, and to make entries on reports and records.

APPLICATION INFORMATION

Course

CDL ACDL B

Start Date:

STUDENT INFORMATION

Full Name of Student/Applicant

First NameMiddle NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com

Have you ever had a CDL permit?*

NoYes

When?

Date

Gender

MaleFemale

STUDENT CERTIFICATIONI certify that I have read and understood the school policy and guidelines. I give my full consent to the school registrar in providing and/or verifying the necessary relevant information pertaining to my academic records as may be deemed necessary for the office of the registrar's processing of the information for purposes relevant to the office's operations. I am aware of the admission and retention policies of the school and hereby undertake in abiding the same. I submit that any false or misleading information provided herein may constitute the forfeiture of the benefits attached for which I or my child may obtain following the approval of herewith. Should I make any change in the information provided herein after the submission of this form, I shall promptly submit an email to the school registrar with the request.Signature First Name Last Name Date

Will the student leave from the program after graduation?

YesNo

STUDENT CERTIFICATIONI certify that I have read and understood the school policy and guidelines. I give my full consent to the school registrar in providing and/or verifying the necessary relevant information pertaining to my academic records as may be deemed necessary for the office of the registrar's processing of the information for purposes relevant to the office's operations. I am aware of the admission and retention policies of the school and hereby undertake in abiding the same. I submit that any false or misleading information provided herein may constitute the forfeiture of the benefits attached for which I or my child may obtain following the approval of herewith. Should I make any change in the information provided herein after the submission of this form, I shall promptly submit an email to the school registrar with the request.Signature First Name Last Name Date