EmailMe Form - Non-Scholarship Registration Form

The Georgia Driver's Education Commission offers the Georgia Driver's Education Grant Scholarship Program to offer driver's education to Georgia students. The grant scholarship program is open to Georgia residents ages fifteen through seventeen who wish to satisfy the Joshua's Law driver's education requirement with an approved instructor and enroll in the Full Course including 30 hours of classroom instruction and 6 hours of behind-the-wheel instruction. Please visit www.georgiadrivers.ga.gov if you wish to apply.

Students who have been awarded a GDEC Grant Scholarship should use the Scholarship Recipient Registration Form link on our website to register.

If you choose to pay the course registration fee out-of-pocket, please continue below. *

I do not meet the criteria for or do not wish to apply for the GDEC Grant Scholarship, and understand that I am responsible for submission of the course fee before my registration is complete.

Once you begin this registration form, you cannot save the form and return to where you left off. Please have the following items prepared before beginning.
1. Print, complete, and sign the Course Forms available on our website.
2. Scan the completed Course Forms.
3. Save all pages of the course forms as ONE file that you can upload. If you are not able to upload the Course Forms during registration or need to upload multiple pages, please submit them using the UPLOAD DOCUMENTS feature under the Course Forms section on our website.
4. Copy, scan, or take a picture of the front of the student's driving permit and save it as a file that you can upload.

For timely processing of your registration, uploading the permit and Course Forms is recommended. You may elect to return these items by mail or in-person drop off, following the directions in the Course Information.

How did you hear about us?

Course Type *

Full Course 30/6 - 30 hrs classroom and 6 hrs behind-the-wheel training (BTWT)

Classroom only - 30 hrs

BTWT (driving) only - How many BTWT hours you would like to purchase?

Course Start Date *

MM / DD / YYYY

For the full Driver's Ed course schedule, visit our website: www.coastalpines.edu/driversed/

Campus *

Student Information

Please provide the STUDENT information in all fields in this section.

Name *

First Middle Last Suffix

Please provide legal name as shown on driving permit.

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Phone

### - ### - ####

Email

Please do not use a school email containing .ga.us

Date of Birth *

MM / DD / YYYY

Age *

Highest grate completed *

Name of High School *

Upload Student's Driving Permit

A valid driving permit is required for courses including BTWT. Please upload now!

Driving Permit Number

Permit Issue Date

MM / DD / YYYY

Permit Expiration Date

MM / DD / YYYY

Upload course forms

To upload here, please complete and save the following course forms as ONE FILE:
Student Code of Conduct Acknowledgement
Student Class Release Form
Off Campus Leave Form
Release of Driving Information and Waiver (appropriate form based on student's age)
Cancellation and No-Show Form
FERPA Release
Driver Training Student Contract
Fee Submission Form (optional - see payment options below)

Forms are available on our website or can be requested by email at driversed@coastalpines.edu. To upload forms that are saved as multiple files, please use the UPLOAD DOCUMENTS feature under the Course Forms section of our website. Forms may also be mailed or dropped-off at any campus location following the instructions in the course information.

Gender* *

Female

Male

Are you Hispanic/Latino?* *

Yes

No

Decline to answer

Race* *

Are you a US Citizen?* *

Yes

No

Decline to anaswer

*Coastal Pines Technical College (CPTC) does not discriminate on the basis of race, color, creed, national or ethnic origin, gender, religion, disability, age, political affiliation or belief, genetic information, veteran status, or citizenship status (except in those special circumstances permitted or mandated by law).

Parent/Guardian Information

Please provide information for the PARENT or LEGAL GUARDIAN in all fields in this section. Students 18 years or older are not required to provide this information.

Name

First Last

Email

Cell Phone

### - ### - ####

Home or Work Phone

### - ### - ####

Emergency Contact

Name *

First Last

Relationship to student *

Phone *

### - ### - ####

Email

Payment Options

We are unable to process online payments at this time. Please select one of the following options:

Credit card authorization uploaded with course forms

In person payment - we will generate your student ID and email you a fee submission form

Mail check/money order

Mail credit card authorization

Phone credit card payment - we will call you to accept payment.

Complete and return the fee submission form available on our website with payment. Please do not mail cash. Mailing address: CPTC Driver's Ed, 1777 West Cherry Street, Jesup, GA 31545. Include student's name, course name, and course date on check/money order. We do not recommend submitting credit card authorizations by email or fax. Students must be assigned a student ID for payment processing. Please do not attempt in-person payment submission before the registration is processed and the student ID has been generated.

Thank you for choosing CPTC Driver's Ed!

Please be sure to read and understand the course information available on our website: www.coastalpines.edu/driversed/. Once your registration is processed, you will receive an email with information about your enrollment status. Enrollment is complete upon receipt of all course forms, receipt of the course fee, and submission of the driving permit (permit not required for classroom-only course).

We welcome your feedback!

For help, course forms, questions, or additional information, you may also email driversed@coastalpines.edu.