STATEMENT OF ASSURANCE

I, ________________________, attest to GetDefensive.com and the Texas Education Agency,
the following:

  1. I will complete and/or have completed this online adult driver education course with no help from any person, other than the staff of GetDefensive.com.
  1. I will not/have not misrepresented my identity in any way during this online defensive driving course.
Student Signature   Date
Notary Signature   Date

Notary Seal

Copy of your government-issued photo identification below

Please return this form to GetDefensive.com
Via Fax: 1-800-519-3475

Or mail to:

640 S. San Vicente Boulevard,
Suite 490, Los Angeles, CA 90048