wpps test form

General Information

First Name

Middle Name

Last Name

Date of Birth

Permit/License#

Issue Date

Phone

Street Address

City

Zip

Pick up Address, if different from above

Refer By

Lesson

Hours

Instructor

Amount Paid

Authorization

Cardholder

Payment Method

Please Initial

Date

Time

Keys:

LEVEL OF INSTRUCTION:
I. Introduced Maneuver
X. Extended work on maneuver
R. Reviewed Maneuver
C. Coincidental use of maneuver

PERFORMANCE MANEUVER
4. Excellent consistently
3. Usually does well, but sufficiently consistent
2. Occasionally does well, but needs substantial work
1. Poor grasp of fundamentals of maneuver

Pre-drive Set Ups

Speed Control

Acceleration / deceleration

Maintains Speed Limit

Covering Brake

Blind, uncontrolled intersection

Blind, uncontrolled railroad crossing

School / senior zones

Construction zones

Following distance

Stoppings

Basic braking to stop

Stop sign/light with limit line

Stop sign / light with crosswalks

Railroads crossing

School bus

Behind other vehicles

Steering control

Hand position

Slalom course

Curves

Hand over hand turns

Straightening

Position within lanes

Right Turn

Mirrors/blind spot

Approach position

Speed control

Steering control

Single turn lane to single lane

Single turn lane to multiple lanes

Multiple turn lanes

Left turn

Mirrors/Blindspot

Approach position

Speed control

Steering control

Single turn lane to two-lane

Single turn lane to multiple lane

Multiple turn lanes

Turnabouts

U-Turn

3-Point turn

2-Point Turn

Lane changes/ Passing/Being Passed

Mirrors/Blindspot

Appropriate gap

Speed control

Steering control

Expressway Driving

Entrance ramp / acceleration lane

Gap identification

Mirrors/Blindspot

Speed control

Steering control

Deceleration lane / exit ramp

Backing

Looking over shoulder

Speed control

Steering control

Parking

Hill parking

Diagonal Parking

Perpendicular parking

Parallel parking

Driving in Bad Weather

Visual adjustments

Following distance adj

Night Driving

High / low beam use

Scanning adjustments

Identification Skills

Long distance scanning

Intersection scanning

3-to 5-sec mirror use

Mirrors/Blindspot

Identifying, predicting other users

Identifying, traffic controls

Identifying, changing road conditions

INSTRUCTOR NOTES

Completion Certificate Number

Next Appointment

A $45 rescheduling fee may be applied for cancellations with less than a 24-hour notice. $45 fee for returned checks

I have completed this form with true information

(562) 504-8570

General Information

Pre-drive Set Ups

Speed Control

Stoppings

Steering control

Right Turn

Left turn

Turnabouts

Lane changes/ Passing/Being Passed

Expressway Driving

Backing

Parking

Driving in Bad Weather

Night Driving

Identification Skills

INSTRUCTOR NOTES

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(562) 504-8570