Driver Ed Teacher Survey

Purpose of this survey:

The results of this survey will assist the Transportation Safety Division (TSD) of the Oregon Department of Transportation (ODOT)
to update our driver education teacher information and determine the status of you meeting the 2007/2008 instructor requirements.  

*Note:  You will want to print a copy of this form for your records.

Please provide the following contact information:

Name (Last , First)

  Drivers License Number: 

Home Address

Home City, State and Zip

City:         State:     Zip: 

School/Business Name

School/Business Address

 School/Business 

City:         State:      Zip: 

Work Phone

  (ex: 503-555-1212)

Home Phone

  (ex: 503-555-1212)

FAX

  (ex: 503-555-1212)

Home E-mail

Work E-mail

1.)  Are you currently teaching Driver Education? Yes  No

2.) What DE Course(s) do you teach? 

3.) You teach Driver Education through the following: (check all items that apply)

Private Provider:        Commercial School            Individual

Public Provider:          Public High School             Community College  

Education Service District



4.)    Have you received any of the following Driver Education courses since 2004: 

 

Foundations      Yes  No

BTW                Yes  No  

Classroom        Yes  No

 

5.)  If needed, indicate the locations where you would  attend these courses:

                        

 Other Location Not in Above list (type In)  

6.) Comments

              

 

 

                  

 

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Oregon Department of Transportation-Transportation Safety Division
ODOT · Search · ODOT FTP · Alternative Menu
 235 Union St. NE, Salem OR 97301-3871
Phone: 503-986-3883