Fillable Drivered-student-information Driver Education – Student Information Form

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Drivered-student-information Driver Education – Student Information Form

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Hudson Valley Community College
Community & Professional Education
Driver Education – Student Information Form
Please PRINT all information clearly
Full Legal Name:____________________________________________________________________
Last First M.I.
(as it appears on your Permit or License)
License/Permit ID#:___________________________ Date of Birth:____________________________
Street Address:_______________________________________________________________________
City, State, Zip:_______________________________________ Phone:__________________________
(
Cell is preferred in case of cancellations)
Email address:__________________________________________
What school do you attend?_______________________________
Parent/Guardian Name:______________________________ Phone:__________________________
I_________________________________, understand the Attendance Policy as it is outlined in this packet and agree
(Student name-please print)
to abide by it and be held responsible.
Student’s Signature: ____________________________________________________________________
I hereby give consent for my son/daughter to take Driver Education at Hudson Valley Community College and have
reviewed the attendance policy with my son/daughter.
Parent/Guardian Signature: ________________________________________________
Hudson Valley Community College
Office of Community & Professional Education
80 Vandenburgh Avenue, Troy, NY 12180
Phone 518-629-7339 Fax 518-629-8103
Email: communityed@hvcc.edu
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Drivered-student-information Driver Education Student Information Form

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Completed 5 December 2019

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