School Information
Instructor’s First Name: Russ Yost
Instructor’s Last Name: Yost
Instructor’s Phone Number: 316-448-2072
Instructor’s Email: info@yostdrivingschool.com
School Name: Yost Driving School
School Address Line 1: 1735 E 2nd St
School Address Line 2: Ste A
School City: Wichita
School State: KS
School Zip: 67214
USD No: N/A
Student Information
Legal First Name: Jeremiah
Middle Name: Dashawn
Legal Last Name: Jackson Reed
Suffix : Please Select. . .
Phone Number : 3163049696
Address Line 1: 800 n Farmington dr
Address Line 2:
City : Derby
State: KS
Zip : 67037
Sex: Male__X__ Female_____
Date of Birth: 07/27/2006
Eye Color: BRO
Height: __6___ft __1___In
Weight in lbs: 145
License Questions
Are you a resident of Kansas? Yes__X__ No_____
Have you attended driver education in the past 12 months? Yes_____ No__X__
If yes, did you complete and pass driver education? Yes_____ No__X__
Do you have a Kansas Credential (identification, permit, driver's license)? Yes_____ No__X__
If yes, enter the Kansas Credential Number: N/a
Parent and student can sign at the same time or seperately. If the other party isnt present just fill out your part and check "I agree" and "Submit All"
After submitting you can close this window. You can click "Start over" to remove your signatures