Teenage Student Eligibility Disclosure

I have read, understand, and have had fully explained to me by the instructor the requirements of the Secretary of State regarding the issuance of a certificate of completion. I am aware that although I may pass this course, such accomplishment alone will not guarantee my receiving a certificate of completion. Receipt of a certificate of completion is contingent upon successful completion of course, tuition and fees paid in full and eligibility requirements being fulfilled and documented.

I am eligible in one or more of the following ways and attach my signature attesting to the above:

Enrolled in school and have passed at least (8) courses over the most recent (2) semesters.

Enrolled in a home school program

Apply and receive a waiver form from the superintendent of schools.

Reside in Cook County, have dropped out of school, and secured a parental/guardian waiver form.

I have passed (30) hours of classroom and have documentation to prove this.

I have passed the (6) hours of driving and (6) hours of observation and have documentation to prove this.

Student Signature

Name (Please Print)

Date: