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CHANGE REQUEST FORM
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1
Change Disclaimer
*
This field is required.
I understand that any and all changes are subject to approval. I understand that this is not confirmation of any changes, and just a request for a change. You will be notified whether your requested is approved or denied. I understand that NOLA Driving Institute requires minimum notice of 7 days to reschedule driving dates and times. If the minimum requirements are not met a fee will be accessed if your request is approved. FEES MUST BE PAID WITHIN 24 HOURS OF APPROVAL OF REQUEST. Driving dates within 7 days of driving $100.00. Driving dates within 48 hours $200.00. I understand that new driving dates are typically 4-6 weeks if you can drive Monday - Friday 8 am - 4pm 8-12 Weeks if you can drive Monday - Friday 4 pm - 8 pm 10-16 Weeks for weekends
I agree
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2
Name
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This field is required.
First Name
Last Name
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3
Student's Phone Number
*
This field is required.
Please enter a valid phone number.
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4
Parent's Phone Number
*
This field is required.
If 18 or older please just enter 000-000-0000
Please enter a valid phone number.
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5
Email
*
This field is required.
example@example.com
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6
What is your first scheduled day to drive?
*
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Date
Year
Month
Day
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7
What is your secon scheduled day to drive?
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Date
Year
Month
Day
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8
Why is this change needed?
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9
Are you available to drive on Monday?
*
This field is required.
Select times that you are available
8 am - 12 pm
12 pm - 4 pm
4 pm - 8 pm
Can't Drive this day
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10
Are you available to drive on Tuesday?
*
This field is required.
Select times that you are available
8 am - 12 pm
12 pm - 4 pm
4 pm - 8 pm
Can't Drive this day
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11
Are you available to drive on Wednesday?
*
This field is required.
Select times that you are available
8 am - 12 pm
12 pm - 4 pm
4 pm - 8 pm
Can't Drive this day
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12
Are you available to drive on Thursday?
*
This field is required.
Select times that you are available
8 am - 12 pm
12 pm - 4 pm
4 pm - 8 pm
Can't Drive this day
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13
Are you available to drive on Friday?
*
This field is required.
Select times that you are available
8 am - 12 pm
12 pm - 4 pm
4 pm - 8 pm
Can't Drive this day
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14
Are you available to drive on Saturday?
*
This field is required.
Select times that you are available
8 am - 12 pm
12 pm - 4 pm
4 pm - 8 pm
Can't Drive this day
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15
Are you available to drive on Sunday?
*
This field is required.
Select times that you are available
8 am - 12 pm
12 pm - 4 pm
4 pm - 8 pm
Can't Drive this day
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