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 License 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