Student Information

Student Information

  • Please select your class date:

  • Student Information

  • First Name:
  • Middle Initial:
  • Last Name:

  • Date of Birth:
  • Driver License Number: (If DL is longer than 8 digits, enter the last 8 digits only)
  • Driver's License State:
  • Sex:

  • Phone:

  • Mailing Address

    This is is where your certificate will be mailed if you chose USPS First Class Mail.
  • Street Address: (Please include APT # but do NOT use commas)
  • City:
  • State:
  • ZIP:

  • Reason for Attendance

  • Reason for Attendance:
  • Court Name: (do NOT use commas)

  • Drop files here or
    Max. file size: 2 GB.
      To improve accuracy during certificate processing, you may upload a photo or scan of your court documents and/or driver license here. This field is optional.

    • I certify that the information provided above is true and accurate. I understand that my certificate of completion will be issued using this information. I understand that there will be a $10 fee for each new certificate, after the original, if corrections to this information are necessary.

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