Application

Student Name*

First NameMiddle NameLast NameSuffix

Student First Name*

First Name

Student M.I.

Middle Initial

Student Last Name*

Last Name

Which Session(s)*

Both (If this is the first time filling out an application. This lets me know you want to do the complete Driver's Education program which is required to obtain a license. If you have already filled out an application you do not need to fill out another one.)ClassroomBehind the Wheel (If you took the classroom already and just need BTW)Other

Classroom Start Date*

If there is any issue with any of the scheduled options or any of the specific days don’t work please let me know. There is always an easy solution.

Your student would have to miss a class or 2.Can do first week of one session and second week of anotherOther

If {studentFirst} has to miss a class or two just let us know which ones will be missed and we can make sure to provide the work that will be missing. We have done this for over 10 years and depending on which day(s) missed we have a plan to make sure they don't miss anything. Please follow up if you have any other questions.

If {studentFirst} can do the first week one session and the second week another session that is fine. Please just let us know which other session.

Classroom Start Date

Have you completed the Drivers Ed. Classroom portion already?

Yes I took it at my high school.Yes I took at another driving school whether in-person or online.NoNo, but I am currently taking it.

Student Address*

Street Address

Street Address Line 2

CityState

Zip Code

Date of Birth*

MonthDayYear

Gender

The affiliate I use from DMV requires.

E-mail*

If online class was selected please use e-mail you want to receive the login information.

Student Phone Number*

Area CodePhone Number

High School Attending*

Parent/Guardian Name*

First NameLast Name

Parent/Guardian First Name*

First Name

Parent/Guardian Last Name*

Last Name

Parent/Guardian Contact*

Area CodePhone Number

Parent/Guardian Email*

example@example.com

Payment

Deposit$50.00

Quantity
Item subtotal:$0.00

Classroom$250.00

Quantity

Behind the Wheel$350.00

Quantity

Both$600.00

Quantity

Enter coupon

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

Signature*

How long ago did the student receive their learners permit. Do not stop application if unknow or leave it blank. If you aren't sure just take your best guess.

Additional Sibling or Student?

NoYes

Name

First NameLast Name

DOB

Date

Learners #

If online class second email address

example@example.com

Which Session*

Classroom TrainingOnline ClassBehind the WheelBoth