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Course: CDL Skills Test (Student to Provide Testing Vehicle)

NOTE: Fields marked with are required.

Student Information

Course Session

TBA

LSCPA ID Number (if any)

First Name

Middle Initial

Last Name

Suffix (Optional)

Date of Birth

Email is the preferred method of communication. Please provide an email address that you check regularly. If you do not have an email address, please make sure you provide good contact phone numbers.

Confirm Email

Day Phone Number

Other Phone Number (Optional)

Street Address

Street Address Line 2 (optional)

Street Address Line 3 (optional)

City

County

State

ZIP code

Demographic Information

Are you Hispanic or Latino?

A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Racial Group (select all that apply)

American Indian or Alaskan Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Unknown

American Indian or Alaskan Native: American Indian or Alaskan Native A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

Asian: Asian A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent including, for example,Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine islands, Thailand, and Vietnam.

Black or African American: Black or African American A person having origins in any of the black racial groups of Africa.

White: Caucasian/White A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Native Hawaiian or Other Pacific Islander: Native Hawaiian or Other Pacific Islander A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific islands.

Unknown

Gender

Are you a US Citizen?

No Disclosures found for this course

Acknowledge and Submit Application

Name of Person Filling Out the Application if not the Student

Acknowledgement

By checking this box, I acknowledge and agree to the following statements:

I hereby certify that the information contained in this application is true and complete to the best of my knowledge.
I understand that any misrepresentation or falsification of information is cause for denial of admission or expulsion from the College.
I understand that the faculty and staff of the Continuing Education and Admission and Records offices will read the information contained in this application.
I have read and understood all information included on this application and all related documents and requirements.