Qualtrics Survey | Qualtrics Experience Management

Complete this form after you have completed the Driver’s Test on the State's Division of Risk Management website or if you wish to declare you are a "non-driver".

The training is required for all employees (BC staff, Utah Reads tutors & site coordinators).
Other program participants/volunteers are not required to drive and/or provide a license - driving is optional.

If you passed the State’s Division of Risk Management’s Defensive Driver’s Test with 80% or above, hold a valid driver's license, and agree to hold automobile liability coverage (on personal vehicles), you are eligible.

If you need accommodations to complete this form, please contact your staff partner or supervisor.

Please provide your full, legal name as it appears on your driver's license or governmentally issued identification card

First Name

Last Name

Please provide your contact information

Phone Number

Email Address

University ID Number (u#######)

I plan to (or may) operate a motor vehicle during my participation with the Bennion Center:

Yes
No - I am a non-driver and will never operate a personal or rented motor vehicle during my participation

With which Bennion Center programs do you participate (choose all that apply):

Alternative Breaks
Bennion Scholars
Communication Team
Community Engagement Cohorts
Community Partnership Programs
Residential Engagement & Service House
Utah Reads
Bennion Center Staff Member

What is your University of Utah affiliation:

Student
Staff (Bennion Center)
Staff (any except Bennion Center)
Faculty