Registration - California Smog & Automotive Institute

Student Information

Name*

First Last

Social Security Number (last 4 only)*

XXX-XX-

Please enter a value less than or equal to 9999.

Date of Birth*

CA DL#

State License

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Home Phone*

Mobile Phone

Employers Information "Statement of Fact"

Business Name

Business Phone

Business Fax

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Course Information

Class Schedule: Monday, Tuesday and Wednesday 6:00PM to 10:00PM

Course Name*

Scheduled Start Date*

Scheduled Completion Date*

Payment Options*

All Course Tuition Fees include a $75 registration deposit that is non-refundable. Please select whether you would like to pay just the deposit at this time or the full amount.

Deposit Only
Full Amount

Inspector Licensing Tuition