CDL WCE Registration Form

Commercial Driver's License (CDL) Program Registration Form

Office phone: 903-693-2067 email: cdl@panola.edu
Program Details

Students will receive 160 hours of classroom and hands-on training with experienced instructors. Classes are scheduled for Monday - Thursday from 8:00 a.m. - 6:30 p.m.

Program Requirements
- Must be at least 18 years of age. The U.S. Department of Transportation (DOT) requires that all interstate drivers be at least 21 years of age.
- Must have a clear driving record as determined by the Department of Public Safety.
- Must be able to pass a Department of Transportation (DOT) physical as required by Federal & State agencies.
- Must be able to pass a drug screen when administered.
- Copy of Driver's License.
- Copy of Social Security Card.
- Copy of high school diploma or GED.
Disclaimer
- Successful completion of the course does not ensure eligibility for licensure or future employment.
First Name Last Name
Signature

Clear
Financial Assistance

Scholarships and grants may be available to cover a portion of the program cost. The student is responsible for any balance due before the first class day. Please use the links below for assistance opportunities.

Workforce and CE Scholarship Application
Class choices *
prevnext( X )
CDL Truck Driving Course - Gullette Technology Bldg - Need PermitOctober 7 - November 1, 2024; Monday - Friday ; 8:00am-5:00pm
$5,000.00

CDL Truck Driving Course - Gullette Technology Bldg - Have Permit October 14 - November 1, 2024; Monday - Friday ; 8:00am-5:00pm
$3,500.00

Total

$0.00
Name*

First NameLast Name
Student ID if applicable
Date of Birth*

MonthDayYear
MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Ethnicity and Race
Are you Hispanic or Latino? (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race)*

YesNo
Please select the racial category or categories with which you most closely identify. Check as many as apply.*

American Indian or Alaskan NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhite
Special Population Information
Select all that apply*

NoneDisabledHomelessYouth whose parent is active duty armed forcesSIngle parent, including single pregnant womenEconomically disadvantaged families, including low-income youth and adultsOut-of-workforceYouth in or aged out of foster careIndividual lpreparing for nontraditional fieldBarriers to educational achievment, including limited English proficiency
I give Panola College permission to release my directory information.*

YesNo
Media Release

I hereby authorize Panola College to photograph me and any subject matter owned by me in still picture and motion picture form, and to record my voice, or to cause such photographs and pictures and recording to be made. I hereby consent to the exhibition of such photographs and pictures and the use of my name and voice by you, the world, whether such exhibition and use are sponsored or not. I also consent to the use of such photographs, the right to use my name, voice and photographs and pictures in advertising and in publicity in connection with a subsequent exhibition, and in the exhibition itself. I hereby release you and all other parties from any and all liability, claims or causes of action, arising out of, or created by, the use of my photograph or photographs, picture or pictures, and name and voice, as set forth above. This authorization, consent and release shall apply to all photographs, pictures and recordings of the above-signed, made with the knowledge and acquiescence of the above-signed, from the date hereof until the above-signed shall give you written notice that this authorization, consent and release in no longer effective. This agreement shall be binding on me, my heirs, administrators and executors, and shall inure to the benefit of you, your successors, assigns or licensees.
Signature

Clear
Please upload photos of your Driver's License, proof of high school diploma/GED and Social Security Card*

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