Begin the Registration Process

Student Information

Legal Name:  

Preferred Name:  

Your Information

This is the contact information for the person completing this form.

Your Name:  

Phone: 

Email: 

Relationship to Student:  

Referred By: 

Please check all that apply to the student:

Please explain any items you have checked.

Please Note

You may qualify for the services of our Driver Rehabilitation Specialists (DRS). A successful clinical evaluation by an OT/DRS at UAMS Outpatient Therapy Clinic in Fayetteville might be needed prior to scheduling with Driving Academy of NWA.

Please complete the registration process and someone from our office should contact you within two business days. Depending upon the results of the clinical evaluation, if needed, Driving Academy’s DRS may be required for the training and/or the in-car evaluation.

Confirmation Code: