Impact Texas Teen Drivers

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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:

*Create Password:

Display Password

Minimum of 8 characters. Include at least one upper case, one lower case, a number and one special character: %,&, _, ?, #, =, -

*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:

Format: mm/dd/yyyy

*ZIP Code:

*Driver Education Type:

Parent Taught (PTDE)

Course:

Driver Education School:

TDLR Number:

This can be found on the DE-964 Certificate

High School

School Number:

Out Of State Equivalent

Driving Education Type is required.

*Student's Learners License Number:

Student’s Learners License Number is invalid

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