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Permit/Temporary ID Photo
*
Scan the
FRONT
of your ID / Temporary Permit / Paper Permit:
Point at the
front of your ID / Temporary Permit / Paper Permit
. Fill the frame, keep steady, and use good lighting.
📷
Choose the FRONT Photo
Take a picture or select an existing image
Select photo
No file selected
Don't have your plastic permit? Use the button below to enroll.
Enter Information Manually
Scan the
BACK
of your ID / Plastic Permit:
Point at the
barcode on the back
. Fill the frame, keep steady, and use good lighting.
📷
Choose the BACK Photo
Make sure the barcode is clear and readable
Select photo
No file selected
Submit Your Scanned ID / Plastic Permit
Permit Information
*
Following fields are required.
*
Permit/Temporary ID#:
Permit Issue Date:
Permit Expiration Date:
Student Name
*
First Name:
Middle Initial:
If you do not have a middle initial or a suffix, please, insert a dash!
This field is to be filled out according to your temporary permit.
*
Last Name:
Suffix:
Email Information
*
Email:
*
Reenter Email:
Student does have an email:
Yes
No
Student Birthdate
*
Birth Date:
You need to be born before this date to sign up:
May 22nd, 2011
Student Home Address
Street Address:
City:
State:
Ohio
Kentucky
West Virginia
Pennsylvania
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Oklahoma
Oregon
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Wisconsin
Wyoming
Zip Code:
Student Meeting Place
Meeting Place - Street Address:
Meeting Place - City:
Meeting Place - State:
Ohio
Kentucky
West Virginia
Pennsylvania
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Oklahoma
Oregon
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Wisconsin
Wyoming
Meeting Place - Zip Code:
Phone Contact Information
*
Phone Type (1):
Cell
Home
Parent-Work
Parent-Cell
Work
Extra
None
*
Phone (1):
Phone Type (2):
Cell
Home
Parent-Work
Parent-Cell
Work
Extra
None
Phone (2):
Phone Type (3):
Cell
Home
Parent-Work
Parent-Cell
Work
Extra
None
Phone (3):
Phone Type (4):
Cell
Home
Parent-Work
Parent-Cell
Work
Extra
None
Phone (4):
Parent/Guardian Information
Parent/Guardian Name:
Center/Location Information
*
Choose your location
*
Center/Location:
Choose a Location
BLACK RIVER H.S.
ELYRIA
MEDINA
PARMA/BROADVIEW
ROCKY RIVER
If the city you live in is different than the location you selected, you'll need to meet at that location.
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