Section 1: Personal InformationFull Name *Date of Birth *Gender *MaleFemaleAddressEmail Address *Section 2: Driving LicenseDriver’s License Number *State of IssueExpiry DateUpload License (front/back) (required — file upload) *Drag and Drop (or) Choose FilesSection 3: Driving Background/ExperienceYears of licensed drivingPrevious driving lessons (in-school or private):Specific goals *Section 5: Emergency & Support ContactEmergency Contact Name (required) *Relation to You *Emergency Contact Phone Number (required) *Section 6: Consent & Privacy * Consent to participate and share contact information with DriveTime Assist volunteers and coordinators Agreement to abide by program safety guidelines Media consent (e.g., “I consent to having my photo taken during lessons for internal use.”) Submit
