Segment 2 Registration

An asterisk (*) indicates a required field.
Last Name
First Name
Middle Name
Your full mailing address for Secretary of State Records
Birthdate
EmailĀ (do not enter “AOL.com” Email, we will not receive your registration.)
Please list 2 phone numbers in case one doesn’t work
Which Class Location?



Which Class date and time?
Did you prepay for Segment 2

Level 1 issue date. (top line of numbers)
Have you had your white Level 1 License at least 90 days?

If possible, please send a picture of your Level 1 license
How did you hear about us?



Other information
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Road Tests, Teen and Adult Driver Education, Ticket Resolution