Create Online Application

Complete and submit this form to create an online application account.

Required *

First Name

Middle Name

Last Name

Birthdate

Email Address

Confirm Email

Passwords (PINs) expire every 90 days.
It can have letters, numbers, and special characters.
It must have a minimum of 8 characters and a maximum of 30.
It must include a minimum of 1 special character, 1 number, 1 uppercase letter, and 1 lowercase letter. Special characters are limited to !@#$%^&*()

Confirm PIN

If you have a DI ID number and PIN, you may create an application using these fields.

Email Address