Truck Driver Training Registration Form

Complete the form below to register for truck driver training. Once the Truck Driver Training office receives your registration form, personnel from the Business Office will contact you for payment.
Student's Name Student's Name First Last
Last four digits of SSN or JWCC ID Number
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number Phone Number - ### - ### ####
Email Address
Date of Birth Date of Birth / MM / DD YYYY
Gender

Gender Male Female
Driver's License Expiration Date Driver's License Expiration Date / MM / DD YYYY
Have you taken classes at JWCC before?

Have you taken classes at JWCC before? Yes No
Are you an honorably discharged Veteran?

Are you an honorably discharged Veteran? Yes No
Date of High School Graduation or GED Completion Date of High School Graduation or GED Completion / MM / DD YYYY
Name, City, and State of High School
Which of the following payment methods are you planning to use?

Which of the following payment methods are you planning to use? Workforce Innovation and Opportunity Act (WIOA) Illinois Veterans Grant Self-Funded Other
What is the highest degree you've earned?

What is the highest degree you've earned? Doctoral Degree First Professional Degree Master's Degree Bachelor's Degree Associate Degree Certificate Some College High School Diploma GED None (includes High School Students) Other
Racial and Ethnic Survey (optional)
Are you from one or more of the racial groups? (select all that apply)

Are you from one or more of the racial groups? (select all that apply) Asian American Indian or Alaskan Native Black or African American Hispanic or Latino White Native Hawaiian or Pacific Islander Choose not to respond/unknown
Are you in the United States on a Visa?

Are you in the United States on a Visa? I am a citizen of the United States I am NOT a citizen of the United States but I am a legal resident alien or refugee
Are you Hispanic, Latino or of Spanish origin?

Are you Hispanic, Latino or of Spanish origin? Yes - I am Hispanic or Latino No - I am not Hispanic or Latino
Are there any barriers that would prevent you from participating? (i.e. classroom location, seating requirements, etc.)
How did you hear about the Truck Driver Training course?

How did you hear about the Truck Driver Training course? Website Monthly newsletter Newspaper TV Social Media Other Other
Course Details

Look up specific details on classes, dates, and times by going to the Truck Driver Training page.

Select class you wish to take.
Truck Driver Training Course Dates

Truck Driver Training Course Dates April 8 - May 16, 2024 (class full - will be placed on waitlist) May 20 - June 27, 2024 June 3 - July 11, 2024 (located at SEC in Pittsfield) July 1 - August 8, 2024 July 15 - October 3, 2024 (night class)
Hazmat Endorsement Training Dates

Hazmat Endorsement Training Dates April 29 - May 9, 2024 June 10 - June 20, 2024 July 22 - August 1, 2024 September 3 - 12, 2024

Truck Driver Training Registration Form

Truck Driver Training Registration Form

Complete the form below to register for truck driver training. Once the Truck Driver Training office receives your registration form, personnel from the Business Office will contact you for payment.

Racial and Ethnic Survey (optional)

Course Details