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2. Defendant First Name*

   Your legal first name as it appears on your driver's license.

3. Defendant Last Name*

   Your legal last name as it appears on your driver's license.

5. Defendant Email Address*

   This will only be used for sending court-related messages and not for solicitation.

7. Defendant Driver License Number*

   Only Texas license holders may take a driving safety course unless you are a member, or the spouse or dependent child of a member, of the United States military forces serving on active duty.

8. Citation Number*

   The citation number can be found at the top of the citation. If you cannot find it, please call the court for help at 512-267-9419.

10. Requirements to Qualify:

    Please note that you will be required to upload a copy of your valid Texas driver's license, permit, or military ID card. If you are active duty military or the spouse/dependent of someone who is active duty, please submit a copy of your valid license along with a copy of your military ID.

12. Plea & Waiver*

    1. I waive my right to a jury trial and plead no contest.
13. Texas Residency or Military Status*

    1. I have a valid Texas driver license, permit, or I am a member, or the spouse or dependent child of a member, of the United States military forces serving on active duty.
15. CDL Status*

    1. I do not now have a CDL, nor did I have one at the time of the offense.
16. Proof of Financial Responsibility*

    1. I have proof of financial responsibility (for most individuals, this is an insurance ID card).
18. Driving Safety Course Eligibility*

    1. I have not completed a driving safety course or motorcycle operator's training course for a ticket dismissal within the past 12 months preceding the date of the offense.
19. Court Order Status*

    1. I am not currently ordered to take this course for another court.
21. Mailing Address*

    Enter your mailing street address

23. City*
24. State*
25. Zip Code*
27. Phone Number*

    Enter your phone number as xxx-xxx-xxxx

29. Image of Driver's License *

    Please upload a picture of your driver's license

30. Image of Insurance *

    Please upload proof of financial responsibility (for most individuals, this is an insurance ID card).

31. Image of Military ID (if applicable)

    Please upload a picture of your military ID (if applicable)

34. Electronic Signature Agreement
36. By checking the "I agree" box below, you agree and acknowledge the following:*

    1. I agree
38. Electronic Signature Statement*

    1. Your application will not be signed in the sense of a traditional paper document.
39. Electronic Signature Authorization*

    1. By signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature.
41. Traditional Signature Requirement*

    1. You may still be required to provide a traditional signature at a later date.
42. Certification of Truthfulness*

    1. You confirm that the information you are submitting to the court is true and correct and you understand that it is a criminal offense to file fraudulent records with the court.
44. Electronic Signature*
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit Submit and Print

* indicates a required field