FEH BOCES StudentCDL B Registration Form

FEH BOCES Student

CDL B Registration Form

First Name

Middle Name

Last Name

Date of Birth

Address

City

State

Select or enter value

Zip

Phone

Program Choice

Select or enter value

Is financial assistance needed

Select or enter value

Funding Agency

Class D License Number

CDL Permit

Select or enter value

Driver's Abstract date acquired

Date of DOT Physical

Physical Results

Select or enter value

Date of Drug Test

Drug Test Results

Select or enter value

Are you currently on any medication that can inhibit your driving?

Select or enter value

Is there any known reason, such as criminal history, etc., you would be denied a commercial driver's license?

Select or enter value

Where did you learn about this program?

Select or enter value

Please send copies of Learner's Permit, physical results, drug test and driver's abstract.

Drag and drop files here or

Note

If Additional Hours Are Needed (# of hours x $80.00).
Payment or approved tuition assistance required before final acceptance in class.

Send me a copy of my responses