LAKE LAND COLLEGE
GRADUATE TO SAFETY
DRIVER REMEDIAL EDUCATION COURSE REGISTRATION
Name:
Last First Middle
Mailing Address:
Apt.#:
City:
State:
Zip:
Cell Phone:
Previous Name(s): Gender:
Male Female
- -
Home Phone:
- -
Date of Birth:
MM/DD/YYYY
Email Address:
Driver’s License #:
For more information on the Graduate to Safety course, contact the secretary of state at 217-782-2720.
For more information on the registration process and scheduling, contact Traffic Safety at 217-238-8258 or
trafficsafetyprogram@lakelandcollege.edu.
Are you in the United States on a Visa-Nonresident Alien?
Yes in the United States on a Visa (Provide Home Country of Origin)
Not in the United States on a Visa
Are you Hispanic or Latino (or are you of Spanish Origin)? Yes Hispanic or Latino Not Hispanic or Latino
Are you from one or more of the following racial groups? (Select All That Apply)
American Indian or Alaska Native Native Hawaiian or Other Pacific Islander
Asian White
Black or African American Choose Not to Respond
Please identify your primary racial/ethnic group. (Select One).
American Indian or Alaska Native Native Hawaiian or Other Pacific Islander
Asian White
Black or African American Choose Not to Respond
Hispanic or Latino
Highest degree completed:
Less than High School Certificate Masters Other
GED, year received Associate Doctorate Some College
High School diploma Baccalaureate 1st Professional Unknown
This course is offered in MATTOON ONLY on an
as-needed basis. The cost of the course is $90 and is
non-refundable.
You may reschedule your course date by contacting
Traffic Safety at 217-238-8258 or trafficsafetyprogram@
lakelandcollege.edu. To avoid a rescheduling fee, you
must reschedule at least 48 hours in advance. If you
reschedule less than 48 hours in advance, you will be
charged $25. If you are unable to attend the course,
you MUST notify Traffic Safety in advance or you will be
responsible for the $90 class fee.
To register fill out the form completely and mail along with
check or money order payment to: Lake Land College
Traffic Safety Program, 5001 Lake Land Blvd., Mattoon, IL,
61938. Checks or money orders should be made payable
to: Lake Land College Traffic Safety Program.
Upon receipt of your form and payment, you will be sent a
course confirmation letter in the mail that will include the
date, time and location of your scheduled course.
The five-hour Graduate To Safety Course is required for drivers aged 16-21 who have had their license suspended by the Illinois
Secretary of State. This course is required for license resinstatement.
