L2P Learner Driver Application Form

The personal information in this form is for the purpose of registration as a Learner Driver with the L2P program. The information will be used for this purpose only and will not be disclosed to other organisations unless required by law.


Personal Details

Maximum characters 255
Maximum characters 255
Maximum characters 255
Maximum characters 255
Maximum characters 255
Maximum characters 255

Emergency Contact

Maximum characters 255
Maximum characters 255

Other Information

Maximum characters 255
Options are limited to
Did someone (such as school, TAFE, WDEA etc.) refer you to the program? required
Maximum characters 255
Maximum characters 255
Maximum characters 255

Availability

Options are limited to
Maximum characters 255
Maximum characters 255
Maximum characters 255
Maximum characters 255
Maximum characters 255
Maximum characters 255
Maximum characters 255

Permission to share information

Note: The personal information requested on this form is being collected by the Glenelg Shire Council for municipal purposes as specified in the Local Government Act 1989. The Council will use this information only for the specific purpose of collection or for directly related purposes. The information will not be disclosed except as required or specifically authorised by law. You may request access to any personal information that Council may have collected about you. Also, you may request correction of your personal information if you can establish that it is not accurate or complete. Such requests should be directed to Council’s Privacy Officer on telephone 03 5522 2305.

I give permission for this information to be shared with VicRoads for reporting details. required
I give permission for the person who referred me to the L2P program (details above) to share information with the L2P Coordinator. required
I give permission for information to be shared with the L2P professional instructor. required
Please hold on while your response is being submitted