Student Intake Form (Funded)

Funding Approved Student Intake Form

Congratulations on taking the next steps towards obtaining one of the most impactful tools a person can have: a driver’s license! Independence and enhanced empowerment await you as the rewards for your dedication and efforts in training. Please submit the form below to start the process of getting assigned to an instructor.

After completing this intake form, you will be sent an email listing 3 tasks you must complete before we can assign you to a driving instructor.

1. Read and sign our Driving Student Accountability Contract. This will come from DocuSign and explains our cancellation policy requirements and other expectations of our students.

2. Watch a few short driving videos to prepare yourself better for your first lesson. Then complete our brief 10-question practice test after watching the videos.

3. Send us a picture of your learners permit.

Contact Info

First name

Last name

Preferred Name

Phone

Address of Residence

Address

City

State

Zip code

General Info

Date of Birth

Month

Day

Year

Age

Gender

Country of Origin

English Proficiency Level

Other Languages Spoken

Driver's License Info

Do you have an active Minnesota Learners permit?

Yes

What is your permit number?

Permit Expiration Date

Month

Day

Year

Have you taken the driving (skills) test before, if so how many times have you tested?

Previous driving experience

Availability & Scheduling

Days and times available for driving lessons. (Select all that apply)

Are there any days or times you CAN NOT drive?

We have a strict 24-hour cancellation policy. Failure to provide adequate notice will result in the loss of lesson hours and may lead to termination from the program if it occurs repeatedly. Please respect our instructors’ time.

Anything else you would like us to know about scheduling your lessons?

Driving Test Scheduling

For vehicle availability and coordination, it is sometimes easier for us to schedule your driving test. Would you like us to assist with scheduling your driving test?

If you would like help scheduling your driving test, you’ll need to be available and responsive on the day we look for DMV test times. Can you commit to being responsive that day?