Enrollment Application

Applicant's Personal Information

First Name

Middle Name

Last Name

Address

City

State

Zip Code

Birth Date

Phone Number

Driver’s License #

State Issued

License Restrictions?
YesNo

Student ID (Office Use Only)

Program Applying For (Check All That Apply)

Full Class (B) Commercial Driver License Training Program (ELDT) - $2,500.00Skills and Road Test Preparation (ELDT) (Current Commercial Driver Learner's Permit Holders) - $1,800.00Endorsement (P) (S) + Behind-the-Wheel Training - $1,200.00Virginia Department of Education School Bus Training (County Outreach) - $1,000.00

Program Term (Select Date & Training Type)

August 10, 2026November 2, 2026January 11, 2027February 15, 2027April 19, 2027August 9, 2027September 20, 2027November 1, 2027

On-Site (In-Person) Training(9:30 AM- 12:30 PM)Virtual Classroom (Classroom) Training (6:30-9:30 PM)

Note: The theory training is the only coursework that will be offered virtually. All skills and road test preparation will be conducted in-person at the training facility.

Driving Record and Authorization Release

All applicants enrolling at New Line Institute Inc shall have their driving record reviewed prior to the first day of class. Please complete the information below authorizing the release of this record.

First Name

Middle Name

Last Name

Address

City

State

Driver’s License #

State of Issuance

Date Issued

I authorize the Department of Motor Vehicles to furnish New Line Institute Inc information pertaining to my driving record. I understand that if my license is found to be restricted (by DMV and/or a Court System), I will not be able to enroll until restrictions are lifted.

Medical History Information

New Line Institute requests medical information to provide necessary medical information and assistance if required. List any known medical conditions you may have:

Emergency Contact Information

Name

Relationship

Phone

Address

City

State

Zip Code

Empowering Your Future with a Class B CDL

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(929) 919-0118 admissions@nli.com

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