Student enrollment form

*To enroll in the Passenger Endorsement course, skip this form and email Chad@EliteELDT.com for more info. Thanks!

Student Enrollment Form 2026

First Name *

Last Name *

Name of employer/school (or school code if required)

Leave this blank if it does not apply to you.

Date of Birth (mm/dd/yyyy) *

Driver's License Number *

EXACTLY as it appears on your driver's license (including dashes, spaces, etc).

Driver's License State *

Note: Online courses not valid in WA.

Phone *

Email *

State Payment required)

Select Course *

If you wish to purchase more than one, please complete a separate form for each course.

Select Payment

Card Number

Expiration Date

Security Code

Card Holder Name

Note: If submitting form without payment, select "Credit Card" but leave other fields blank.

Please allow 2-3 hours for your login information to arrive by email. Thank you!