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Initial Orientation Request

In order to enroll you first need to schedule and attend an orientation. The day you attend orientation is your enrollment date. If you are ready to schedule an orientation appointment please fill in and submit the form below. If you have questions before enrolling please email at info@alertdrivinginc.com or contact us by phone.

All of the information below is solely used to process your enrollment. Please fill out the form as completely as possible. If you are unsure what to enter in any of the fields please fill in the field as unsure.

Orientation Date Request Form

Program: *

Select the program you are required to attend.

First Name: *

Last Name: *

Street Address: *

City: *

State: *

Zip Code: *

Phone Number: *

Email Address: *

Driver’s License: *

Date of Birth: *

Court: *

Violation Date: *

County of Your Arrest:: *

Comments: