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Commercial Drivers License Application

NOTE: Fields marked with * are required.

Student Information
Session:*
LSCPA ID Number (if any):
First Name:*
Middle Initial:
Last Name:*
Suffix (optional):
Date of Birth:*	(click or tap for calendar control)
Email (Preferred):	Email is the preferred method of communication. Please provide an email address that you check regularly. If you do not have an email address, please make sure you provide good contact phone numbers.
Confirm Email:
Day Phone Number:*	( ) - Second three digits Last four digits
Other Phone Number (optional):	( ) - Second three digits Last four digits
Street Address:*
Street Address Line 2 (optional):
Street Address Line 3 (optional):
City:*
County:*
State:*
ZIP code:*

Demographic Information
Are you Hispanic or Latino:*	YesNoDecline to Answer A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
Racial Group (select all that apply):*	American Indian or Alaskan Native A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment. Asian A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent including, for example,Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine islands, Thailand, and Vietnam. Black or African American A person having origins in any of the black racial groups of Africa. Caucasian/White A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Native Hawaiian or Other Pacific Islander A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific islands. Unknown
Gender:*	FemaleMale
Are you a US Citizen:*	YesNo

PLEASE READ CAREFULLY
If you have any questions or concerns prior to submitting your application, please contact the Dean of Technical Programs/Workforce Training Office at (409) 984-6238. Space is limited so registration for the course will be a first come, first serve basis. Applicant Eligibility and General Requirements Must be at least 18 years of age. Hold a valid Texas driver's license. Pay for, complete, and pass the Department of Transportation (TxDOT) Physical Examination and Drug Screen. Must be able to read and speak the English language sufficiently to converse with the general public and to make entries on reports and records. Must be interviewed by a Training representative. The applicant's driving record will be reviewed for acceptable standards to meet with employer guidelines. If an individual's driving record is deemed unacceptable by these standards, the individual will not be admitted to this training program. The doctor conducting the Department of Transportation (TxDOT) Physical and Drug Screen will decide if the individual is physically qualified to drive a commercial vehicle according to the standards set forth by the Federal Motor Carrier Safety Regulations. All applicants will be notified as soon as possible concerning their acceptance status to the LSCPA CDL Class A Program. Tuition Cost: $4,200 Upon acceptance into the Program and prior to the first class day, the tuition fee is due and payable to Lamar State College-Port Arthur. Payment may be made by check, money order, credit card, cash, or Letter of Intent from a current/prospective employer or other third party (such as Texas Workforce Commission, Texas Department of Assistive and Rehabilitation Services, City of Port Arthur). Prospective students whose tuition will be paid by an employer or third party must submit a Letter of Intent from the company/third party prior to the first class day stating that the company/third party will be paying the student's tuition for the course. The employer or third party will be invoiced for $4,200 upon receipt of the Letter of Intent. An applicant's place in the class will not be guaranteed until the tuition fee is paid in full. Fees Each applicant will be personally responsible for paying the following fees to the appropriate parties: The Texas Department of Transportation (TxDOT) Physical/Drug Screen (payable to medical facility you choose): $75-$100 (average). 3-Year Driving Record (payable to the Texas Department of Public Safety (TxDPS)): $6.50. Class B CDL Learner's Permit (payable to the Texas Department of Public Safety (TxDPS)): $10.00. Class A CDL (payable to the Texas Department of Public Safety (TxDPS)): Cost depends on the number of years remaining on current license. Acceptance of an application does not guarantee a seat in the course. Classes may fill quickly, preventing you from registering even though you have completed the application process. Students must notify the Continuing Education and the Admission and Records offices of any change in applicant data. Failure to do so may result in the withdrawal of permission to register in the classes or the inactivation of the application. To begin the program, you must: Complete and submit this application. Submit a copy of Social Security card and valid Driver's License. Download, complete, and submit the Self-Pay/EDC Funded form. Download, complete, and submit the Activity Release and Indemnity Agreement. Download, complete, and submit the Acknowledgement and Release form. Download, complete, and submit the Tuition Refund Policy form. Download, complete, and submit the Truck Driving Applicants Questionnaire. Pay your tuition and fees by visiting the Business Office in person, or by phone at (409) 984-6126. Please note some of these requirements have time-sensitive deadlines. Access to Lamar State College-Port Arthur's programs or activities shall not be limited on the basis of race, color, creed, national origin, religion, age, gender, sexual orientation, political affiliation, or physical disability. Applications accepted year round. Completed forms may be submitted in person to the Workforce & Continuing Education Department located on the second floor of the Industry Training Facility at 1048 Lakeshore, or by mail to: Workforce & Continuing Education Lamar State College Port Arthur P. O. Box 310 Port Arthur, TX 77641

Acknowledge and Submit Application
Name of Person Filling Out the Application if not the Student:
Acknowledgment:*	By checking this box, I acknowledge and agree to the following statements: I hereby certify that the information contained in this application is true and complete to the best of my knowledge. I understand that any misrepresentation or falsification of information is cause for denial of admission or expulsion from the College. I understand that the faculty and staff of the Continuing Education and Admission and Records offices will read the information contained in this application. I have read and understood all information included on this application and all related documents and requirements.

LSCPA's Annual Security and Fire Safety Report is provided in compliance with the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act (20 USC § 1092(f), 34 CFR 668.46).