Tri Valley High

Form for Online Course Only (DE101)
*Is a required field

Prior to completing this form please read the following IMPORTANT instructions: Use this form if you intend on enrolling in the online driver education course now. If you are are a Driversity student this form is ONLY for students that reside in the vicinity of the Dublin Driversity™ location. If you do not reside near this location use the menu below to find the correct form and the correct course.


Gain instant access to the course pay your tuition via PayPal.
  Tuition instructions will follow after submitting this form

Step 1

*Student First and Last Name
* DOB: mm/dd/yyyy
*Address, City, Zip
, , CA
*Phone + Area Code
 
*Cell/Other + Area Code
 
* High School Student Attends :  
* Student * Parent e-mail:
*Parent or Guardian Name
*Parent / Guardian Phone
Tuition for the course is $59. Determine how you would like to arrange tuition payment. Please note that you will have the opportunity to pay via PayPal on the next page. Paying with PayPal you will be able to gain instant access to the course.
*Select Preferred Method of Payment
 *Enter Method here
Please acknowledge that you have read and the following terms and conditions by entering your initials in the box below.
1 It is agreed that you are enrolling in a distance learning or online course.
2 You understand that the online version of this course is identical to the course that is taught live. However, you are aware that an online course requires more self-discipline than a live course.
3 You understand there is a 65-day maximum period from the date of enrollment to complete the course.
4 You understand that this course is not transferable into any other course.
5 You understand that should you choose not complete the course, a certificate cannot be issued.
6 You understand that refunds are not available once you begin the course.
You have read 1-6 above and agree by entering your initials here:
 

* Student Signature