Impact Texas Young Drivers

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):

*Confirm Email:

*Password:

*Confirm Password:

*Security Question:

*Security Answer:

*Student's Last Name:

*Student's First Name:

No First Name

Student's Middle Name:

Suffix:

*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:

Licensed

School License Number:

High School

School Number:

Out Of State Equivalent

*DL/ADE/DE Control Number(?):

* Required

Register