+1-203-268-6040

Located In Stratford CT, Monroe CT and Boca Raton (561) 245-4636 FL

Student Information Form

    Student Details
    First Name*
    Last Name
    Date Of Birth*
    Email*
    Street*
    City*
    State*
    Zip*
    Home Phone Number*
    Cell Phone
    Parent Details
    First Name
    Last Name
    Home Phone Number
    Cell Phone
    Email
    Address if different from student.
    Street
    City
    State
    Zip
    Learner Permit Picture*
    Parent Drivers Lenience Picture
    *** Parent information not needed if student is over 18.

    388 Main Street
    Monroe, CT 06468
    203-268-6040

    45 North Parade Street
    Stratford, CT 06615
    203-268-6040

    The DDEC Boca Raton
    7777 Glades Road, Suite 100
    Boca Raton (561) 245-4636, FL 33434