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CDL Training
217-238-8239 or email us
Workforce Development Center

CBI – Commercial Truck Driver Training Registration

Have you previously attended Lake Land College?
Yes No

What year did you attend?
Year attended must be a valid 4-digit year

*First Name

Middle Initial

*Last Name

Previous Name(s)

*Home Address

*City

*State

*Zip Code
Zip Code format must match: 99999
*County

Home Phone (including area code)
Cell Phone format must match: 999-999-9999
Cell Phone (including area code)
Cell Phone format must match: 999-999-9999
*Email
Email format must match: email@address.com
Disclosure of information protected by privacy laws such as FERPA and GLBA is prohibited.

*Date of Birth

*Gender

*Are you a parent?

*Are you Hispanic or Latino?
Yes Hispanic or Latino
No Hispanic or Latino

*Are you from one or more of the following racial groups? (Select all that apply)

	Asian
	American Indian or Alaska Native
	Black or African American
	White
	Native Hawaiian or Other Pacific Islander
	Choose Not to Respond

*Please identify your primary racial/ethnic group (Select one)

Asian
American Indian or Alaska Native
Black or African American
Hispanic or Latino
White
Native Hawaiian or Other Pacific Islander
Choose Not to Respond

*Are you in the United States on a Visa - Nonresident Alien?
Yes in the United States on a visa
Not in the United States on a visa

Provide Home Country of Origin

*Driver's License Number

*State of Driver's License

*Last High School Attended

*City of Last High School Attended

*State of the Last High School Attended

Year graduated from high school or expected to graduate
Year graduated format must be a valid 4-digit year
Year received GED
Year received GED format must be a valid 4-digit year

List ALL colleges/universities attended or now attending write “none” if you have never attended a college/university
Name

City

State

Name

City

State

Name

City

State

Highest Degree Earned

Academic Program (for office use only)

Degree/Certificate Objective
Only complete one or several courses not pursuing a degree.

Transfer Intent
Do you plan to transfer to a 4 year college or university?
Yes No

Student Intent
Personal interest/self development not career oriented

Residency Status:
Have you resided in the Lake Land College District for at least the immediate past 30 days?
Yes No

If you recently moved (less than 30 days) into this community college district to establish permanent residency for reasons other than attending Lake Land College, please specify reason for move

Student Type
Are you currently enrolled full time at Eastern Illinois University?
Yes No

Apply for Term Beginning
Apply for Term year must be a valid 4-digit year
Fall Spring Summer

Course(s) Registered

NDP.CTDT

Commercial Driving License Training

*Are you or your spouse a veteran or current National Guard or Reserves?
Yes
No

Are you company sponsored?
Yes
No

*Select a course start date

*Please list company name

*Applicant Certification:

I understand that withholding information requested on this application, or giving false information, may make me ineligible for admission to the College or subject to dismissal. With this in mind, I certify that the above statements are correct and complete.

*What is the current 4-digit year? (ex. 2025)

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Diversity, Equity and Inclusion

Lake Land College is committed to developing and maintaining an environment for students, employees and college community that embraces and actively supports diversity, equity and inclusion. We aspire to be an institution where the quality of education and work environment are enhanced and enriched by an inclusive campus community that encourages multiple perspectives and the free exchange of ideas.

Equal Opportunity Notice of Non-Discrimination

EQUAL OPPORTUNITY NOTICE OF NON-DISCRIMINATION Lake Land College is committed to maintaining a working and learning environment that promotes equal opportunity, that is free from discrimination and harassment and that prohibits sex discrimination under Title IX, in any education program or activity, including in admission and employment. Individuals may report questions or concerns to the Office of the Director of Human Resources/Title IX Coordinator 217-234-5210. See Board Policy 11.01 for the College's complete Equal Opportunity Notice of Non-Discrimination.

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