What phone number should the online or in-car instructor use to get in touch with a parent? *
Your answer
What is the first name of the student as it appears on their birth certificate? *
Your answer
What is the last name of the student as it appears on their birth certificate? *
Your answer
What is the date of birth of the student enrolling? You must be 14 years of age before completing any online quizzes or taking the handbook exam. You must have been born before 5/1/2011 in order to enroll in driver education for this coming summer. *
Date
What grade is the student currently in? *
What School building does the student attend? *
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This form was created inside of Southeast Kansas Education Service Center.