Course Completion Certificate Request
Only complete this form AFTER your 6th BTW lesson, all 30 hours of Classroom are complete and No Balances due.
Email address
Student First Name
Your answer
Student Last Name
Your answer
Instruction Permit Number (DL #)
On your PERMIT the Number just below your Signature, looks like this A999-9999-9999-99
Your answer
Email Address to send Confirmation to:
Your answer
Phone Number
Your answer
Road Test date (or none)
Your answer
Date of your 6th BTW Lesson)?
MM
/
DD
/
YYYY
Who was your instructor at your 6th BTW Lesson?
NOTE: If you have NOT completed all of your Classroom session including any make up classes or all of your BTW Lessons STOP here and submit this AFTER you complete. Otherwise: I, the above student, certify that I have completed 30 hours of classroom, 6 hours of Driving Behind the Wheel and 6 hours of Observation.
I understand that my completion will be submitted directly to the DMV computer system and it can take 1-2 business days to transmit you information to them. If your road test is TODAY or TOMORROW send us an email right now to prompt us to get your info submitted.
Required
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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