Request New Certificate

Student's Legal Name*

First Middle Last

Date of Birth*

Driver's License #

Phone*

Current Mailing Address*

Street Address City State ZIP

Driving School Location*

Please select the driving school where you took your course:

Class Date*

When did you take the course? (If unknown, please estimate):

Reason for Attendance

Why did you take Defensive Driving on the above date?

Ticket Dismissal

Insurance Discount

Education

Court Information

Please enter your court information as it appears on your citation or court issued documents:

Reason for New Certificate*

Please select the reason for your new certificate request:

I have NOT received my certificate

I received my certifcate, but it shows incorrect information

I received my certifcate and it is correct, but I would like an additional copy

I have NOT COMPLETED the course, I would like to update the method of delivery

Change(s)

Please select what information requires a change (select all that apply):

Name

Address

Date of Birth

Driver's License Number

Court Information

Reason for Attendance

Changes (Description)

Please describe all necessary changes:

Certificate Delivery*

How would you like to receive your new certificate?

Email (typically delivered within 2 business days)

USPS First Class Mail (typically delivered in 7-10 business days)

Both Email & USPS First Class Mail

Trackable/Rush USPS Priority Mail Processing

Email*

Price

Price:

All new certificate requests made after 30 days from the original class date are subject to a processing fee. This fee also applies to all "additional copy" requests.

Price

Price:

All "additional copy" requests are subject to a processing fee.

Price

Price:

Certificate Method of Delivery Upgrade Fee

Price

Price:

Multiple delivery method processing fee.

Price

Price:

Trackable/Rush processing fee.

Signature*

Total

Request New Certificate

Hi!

Haven’t received your certificate of completion? …

Need to make corrections to your certificate? …

You’re in the right place!