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:   Rana
Middle Name: 
Legal Last Name:  Izzo
Suffix :  Please Select. . .
Phone Number :  3166183845
Address Line 1:  7400 E 32nd St N
Address Line 2:  Greenbrook townhomes, apt# 301
City :  Wichita
State: KS
Zip :  67226
Sex:     Male_____     Female__X__
Date of Birth:  04/16/2007
Eye Color:  BRO
Height: __5___ft     __62___In
Weight in lbs:  117

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__X__     No_____
    If yes, enter the Kansas Credential Number:  K04-63-7864

 


     Page 1 of 6    

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

Student Signature



Parent Signature




27780