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IMPACT Texas Young Drivers
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Register
Note: This registration form must be completed with the student's information. The Completion Certificate will only print for the name registered on the account.
Note: If your student does not have an email address, many companies offer free email service. You can sign up for a free email address at any of the major providers.
*Student's Email (User Name):
Email Address is Unique.
Email Address is already in use.
*Confirm Email:
*Password:
*Confirm Password:
*Security Question:
--Select a Security Question--
In what city does your eldest sibling live?
What is the name of the city where you were born?
What is the name of your favorite teacher?
What is your father’s middle name?
What is your maternal grandfather’s first name?
What is your mother’s middle name?
*Security Answer:
*Student's Last Name:
*Student's First Name:
No First Name
Student's Middle Name:
Suffix:
--Select a Suffix--
Jr.
Sr.
I
II
III
IV
V
VI
VII
VIII
IX
X
*Student's Date of Birth:
*Social Security Number:
I certify that I have not been issued a Social Security number.
Check if 25 and over and never taken a driver education course (within the last 2 years)
*Driver Education Type:
Parent Taught (PTDE)
Course:
--Select a Course--
101 - Texas Parent Taught Driver Education Model Program
102 - National Driver Training Institute
103 - Driver Ed in a Box
104 - Curb Buster
105 - Driver Ed at Home
106 - Ready Set Drive
107 - Virtual Drive of Texas
108 - DriversEd.com
109 - I Drive Safely
110 - America’s Driver’s Ed
111 - TeenDrivingCourse.com
112 - Safe2Drive
113 - American Safety Council
114 - Driver’s Education 101
115 - All Star Driver Education, Inc.
116 - Aceable Drivers Ed App for Mobile
119 - TexasParentTaughtDrivingCourse.com
121 - ParentTaughtDrivingCourse.com
125 - Tiffany's PTDE Course 123
126 - Tiffany's Other Course
174 - DrivingQuest
175 - EZParentDriversEd.com
180 - GoToDriversEd.com
189 - Community Driving School
190 - Southlake Driving School
191 - HEB Driving School
192 - Denton Driving School
203 - Easy Texas Drivers Ed
C3267 - Safety First Driving School
C3277 - Friendswood Driving School Inc
C3286 - EMS Drivers Ed School LLC
PT131 - Teen Choice Driving
PT179 - Easy Drivers Ed
PT192 - Denton Driving School
pt195 - diyteendriving.com
pt196 - happytimedrivingschool.com
PT200 - Easy Teen Drivers ED
PT201 - Fast Easy Drivers ED
PT202 - State Approved Drivers Ed
Licensed
School License Number:
High School
School Number:
Out Of State Equivalent
*DL/ADE/DE Control Number(
?
):
* Required