5 Hour Pre-Licensing Course Registration
DIRECTIONS: READ FIRST

Enter student information exactly as it appears on the student's learner's permit. Student information entered here is used to complete the 5-Hour Course Completion Certificates. The NYS DMV will reject any certificates with information that does not match precisely with the student's learner's permit.

Classes will be held from 3:30-8:30 p.m. in Charles O. Dickerson High School Room 226. Students must arrive promptly at 3:15 p.m. to complete paperwork.

Please mail your $30 registration fee to:

TCEP
April Leiter
100 Whig Street
Trumansburg, NY 14886


*Payment must be received prior to the date of the course to ensure attendance to the class.
*It is your responsibility to submit your 5-Hour Course Completion Certificate to the NYS DMV.
*BRING YOUR PERMIT TO CLASS

Parent First Name *
Your answer
Parent Last Name *
Your answer
Parent Phone Number *
Your answer
Parent E-mail Address *
Your answer
Student First Name *
Your answer
Student Last Name *
Your answer
Student Middle Initial *
Your answer
Student E-mail Address *
Your answer
Student Date of Birth *
MM
/
DD
/
YYYY
Student Eye Color *
Your answer
Student Mailing Address *
Your answer
ID # *
9 digit number on permit
Your answer
Learner's Permit Issue Date *
MM
/
DD
/
YYYY
Course Date *
Select the date of the 5 Hour course in which you would like to participate. Please note, there is a maximum capacity of 20 students per class. Classes which reach this capacity will be removed from the list.
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