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)

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*

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.

We ask this in order to best serve you and so we know when to follow up about scheduling Behind the Wheel if we don't hear from you about scheduling or you haven't already. We usually book 1-2 months in advance so the earlier the better and if you forget to schedule in a timely manner this information will allow me to reach out so you won't try to schedule the week of their eligibility and your new driver can get their license on time.

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

Additional Sibling or Student?

NoYes

Name

First NameLast Name

DOB

Date

Learners #

If online class second email address

example@example.com

If only paying the deposit an invoice will be sent for the balance of the classroom and for Behind the Wheel if "Both" was selected at the top of the form. Otherwise the invoice will just be for the balance of the class. If the class is online the balance is due within 7 days and if not paid within 30 days the DMV affilate will put a hold on account. If taking the class in person you can pay the invoice or pay on the first day of class.

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

Credit Card

Signature*

Clear

Type a question

Which Session*

Classroom TrainingOnline ClassBehind the WheelBoth

Invoice for Balance

Classroom Balance OnlyClassroom Balance and Behind the Wheel