Students Enrolled in Commercial Driving Training

Form No. 0-03-02-104 (03.14)

STUDENTS ENROLLED IN COMMERCIAL DRIVING TRAINING

January 1, 20 to December 31, 20

*Please return this completed form to Joan Peterson, Consultant, CSAS, Driver Education, LSOB, 900 SW Jackson St, Suite 653, Topeka, KS 66612 by January 31st .

School Address

A student must be taught a minimum of eight hours in the classroom and six hours behind the wheel to complete the program.

Name of Student / Birthdate / Hours
Class-
Room / Hours
Behind
Wheel / Program
Completed / Date
Started / Date
Completed / Date
Dropped
Yes / No
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The Kansas State Department of Education does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups. The following person has been designated to handle inquiries regarding the non-discrimination policies: KSDE General Counsel, Office of General Counsel, KSDE, Landon State Office Building, 900 SW Jackson, Suite 102, Topeka, KS 66612, (785) 296-3201