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Drivers Education Application Summer 2015

This document is a driver's education application for the William Floyd School District. It provides instructions for eligibility, fees, and how to fill out the application form. Applicants must be district residents and possess a valid learner's permit or driver's license. The non-refundable fee is $380. The application requests the applicant's name, address, contact information, date of birth, permit/license number, and medical conditions. It requires signatures from both the parent/guardian and student to acknowledge understanding and agreement of the rules.

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William Floyd School District
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1K views1 page

Drivers Education Application Summer 2015

This document is a driver's education application for the William Floyd School District. It provides instructions for eligibility, fees, and how to fill out the application form. Applicants must be district residents and possess a valid learner's permit or driver's license. The non-refundable fee is $380. The application requests the applicant's name, address, contact information, date of birth, permit/license number, and medical conditions. It requires signatures from both the parent/guardian and student to acknowledge understanding and agreement of the rules.

Uploaded by

William Floyd School District
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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OFFICE USE ONLY:

APPLICATION RECD:________;

WILLIAM FLOYD SCHOOL DISTRICT


DRIVERS EDUCATION APPLICATION

AMOUNT RECD______
CHECK #:_______ / M.O______

PLEASE MAKE SURE TO READ AND FILL OUT THIS FORM


APPLICATION DEADLINE: __June 12, 2015 @ 4pm______
Eligibility: You must be in possession of a valid New York State learner's permit
or driver's license to submit an application.
Fee: $380.00 (Non-refundable once classes start) William Floyd District Residents Only
Cash or Money Order made out to William Floyd School District

1. Name: PRINT your name EXACTLY as it appears on your LICENSE/LEARNERS PERMIT.


___________________________________
_________________________________________________________
Last Name
First Name
Middle Name
2. Address: __________________________________________________________________________________
Number
Street
Town
3. Phone Numbers: __________________________________
Home Phone Number
4. Date of Birth:

________/_________/__________

_____________________________
Your Cell Phone Number
Grade:___________

Age:__________

5. Permit Number:_______________________ (OR) Drivers Licenses Number:_______________________


6. Do you have any medical condition(s) which could affect your ability to drive?

YES:__________ NO:___________ If Yes Explain:_______________________________________


I hereby give my permission as parent/guardian to enroll my child in Driver's Education. My
signature acknowledges my understanding and agreement to all rules/regulations listed below.
Parent/Guardian Name:

____________________________________________________________
Please Print

Parent/Guardian Signature: _______________________________________________ Date: _______________


I, as a student, agree to abide by all Drivers Education rules and regulations listed below.
Student Signature:

_______________________________________________ Date: _______________

QUESTIONS: CALL DRIVER EDUCATION COORDINATOR, DAWN DUCOING @ 631-874-1678

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