ORCHARD VIEW SCHOOLS

Office Use Only: Seg 1 & Seg 2: Seg 2 only

PROVIDER CERT # P000559

Instructions held: OVHS 16 N. Quarterline Rd, Muskegon, MI 49442 Contact: Trena Strieder 231-760-1492 or OVCE 231-760-1350 8am-5pm
$290 OV student / $350 non-OV $50

Orchard View Schools

DRIVER EDUCATION #509

APPLICATION / CONTRACT 2012/13
______________ Middle Students Address: Parents Address: City / ZIP School Attending / Grade Emergency Phone#: Last

Paid: $ ____________ Method of payment: CHECK # ________________, CASH , MASTER / VISA

School Rep: Students Name: Date of Birth: Parent/Guardian: Home Phone #: Cell Phone #: Emergency Contact: ____________ First date:

Applications will be accepted until deadline date or classes are full. Limited openings are available. Prices, schedule, dates/times are subject to change. Classes may be cancelled due to low enrollment Fee for Seg.1 is $290 for students enrolled and attending Orchard View payment expected in full at time of application deadline date (price includes Seg 2). $350 for non-OV students, regardless of residency (price includes Seg 2) Any Student wanting ONLY Seg.2; fee is $50

Only one absent or 3 tardies allowed in Seg 1. 0 absents allowed in Seg 2. Thereafter, in either Segment, student will be dropped, NO REFUND. It is the students responsibility to arrange with their instructor make-up time . Full refund or transfer to next available course is offered prior to student attending 1st day of class, only. Payment methods: cash, Master/Visa card, or checks payable to: Orchard View Community Ed

SEGMENT 1
Request Class Program/ Class ID# 190 Criteria DOB prior 10/11/1997 DOB prior: 11/9/1997 DOB prior: 01/24/98 DOB prior: 06/19/98 Application Deadline May 11, 2012 Session Dates June 11-28, 2012 Parent/Student Orientation

MANDATORY
Sat. May 19; 9am OR Wed May23; 6pm Sat. June 2; 9am OR Wed June 6; 6pm Sat Sept 15; 9am OR Tues Sept 18; 6pm Sat Feb 9; 9am OR Tues Feb 12; 6pm

191

June 1, 2012

July 9-26, 2012

195

Sept 7, 2012

Sept 24Oct 31, 2012

196

Feb 1, 2013

Feb 19Mar 28, 2013

SEGMENT 2
Request Class Program/ Class ID# 192 193 194 197 Criteria Level 1 prior: Feb 13, 2012 Level 1 prior: May 7, 2012 Level 1 prior: Aug 6, 2012 Level 1 prior: Nov 5, 2012 Application Deadline May 7, 2012 July 27, 2012 Oct 26, 2012 Jan 25, 2013 Session Date May 21-23, 2012 Aug 20-22, 2012 Nov 5 7, 2012 Feb 4-6, 2013

This provider is certified by the Secretary of State. If you have any complaint, which you cannot settle with this school, write: Michigan Dept. of State, Driver Programs Division, Lansing, MI 48918 Completion of driver education instruction does not guarantee qualification for a driver license

All school rules apply to Dr. Ed. Program. If a student is withdrawn due to disruptive behavior, inappropriate conduct, suspension, or explosion, the student will be dropped with NO Refund. Orchard View Public Schools will conduct the behind-the-wheel instruction in a dual controlled automobile and is fully insured., covering each student enrolled in the program. Rev02/22/12

Student and Parent/Guardian MUST sign back of this application, indicating understanding the rules and guidelines.

ORCHARD VIEW SCHOOLS

PROVIDER CERT # P000559

Instructions held: OVHS 16 N. Quarterline Rd, Muskegon, MI 49442 Contact: Trena Strieder 231-760-1492 or OVCE 231-760-1350 8am-5pm

FEES: PAYMENT IS DUE WITH APPLICATION. Student enrolled and attending Orchard View, fee $290. Student not enrolled nor attending Orchard View regardless of residency, fee $350. Students repeating the program (due to absences, tardiness, classroom or driving failure, etc.) will be charge at full cost. Full refund or transfer to next available course; prior to students 1 st day of class. SEGMENT 1: 24 hours of classroom instruction, 6 hours driving time, and 6 hours of observation Parent and student MUST attend the MANDATORY orientation for Seg. 1 Session. Students must be 14 years, 8 months by the first classroom session, verification by birth certificate is required. Students must have 20/40 or better corrected vision, Vision Screening Required Students must have no uncontrolled health problems related to seizures. Attendance: Only ONE absence (three tardies equal one absence) is allowed Seg 1. If a student has more than one absence, they will be dropped at their cost, NO REFUND. It is the students responsibility to arrange with their instructor make-up time for instructional period they were absent. Classroom and pick-up site for driving sessions with be at same location: OVHS 16 N. Quarterline Rd. To receive Seg. 1 Certificate student must pass 24 hrs. classroom instruction (homework, quizzes & State Test 70% or better), min. 6hrs. drive time, and 6 hrs of observation. OV allows one State retest, failure will result in failure to Seg. 1 LEVEL I Allows students to drive with parent or an adult 21 years of age with parent/guardian permission. Student & parent apply at Sec. of State Bring: Cert. Social Security Card, Org. Birth Cert., School ID card, Dr. Ed. Cert., Utility bill, School transcript Student must be a minimum of 14 years, 9 months. SEGMENT TWO: 6 hours of classroom instruction on defensive driving Verification must be received that the student has completed: A min. of 30 hrs. of driving (including 2 hrs. at night) with a licensed parent/guardian on a Level 1 License And held Level 1 license for not less than 3 continuous months. No absences or tardies allowed for Seg. 2 To receive Seg 2. Certificate student must pass 6 hrs classroom instruction (homework, quizzes) and State Test 70% or better OV allow one State retest, failure will result in failure to Seg 2. ROAD SKILLS TEST: Schedule with independent testing agency Complete/signed driving record of 50 hours, Seg. 2 cert, valid vehicle reg. and proof of insurance cert. Upon completion, apply at Secretary of State for Level 2 licenses. LEVEL 2 DRIVERS LICENSES: Allows the student to without supervision (CANNOT drive between 10pm and 5am.) Students must be at least 16 years of age. Must have possessed Level 1 license for at least 6 months. Student must have had no moving violation within 90 days prior to application. Only one passage under age 21yr in vehicle unless traveling to-from school event LEVEL 3 DRIVERS LICENSES Full driving privileges
Parent/Guardian Signature: Student Signature: OV Provider Signature: Date: Date: Date: Rev.02/22/12

Orchard View Schools DRIVER EDUCATION #509 APPLICATION/CONTRACT 2012/13