Student Intake

Let’s see where you are—and where you’re ready to go.

Complete this form before class. When you tap Email My Completed Form, your answers will open in an email addressed to Raw Chaos. Review it, then tap Send.

1. Student Information

Full name *

Preferred name

Email address *

Phone number *

City

State

2. Trucking Background

Currently a truck driver?

YesNo

How long have you been driving?

Own or operate a truck?

YesNo

Planning to become an owner-operator?

YesNoNot sure

Equipment you use or want to learn

Dry vanReeferFlatbedStep deckOther

3. Dispatch Experience

Ever dispatched before?

YesNo

Worked with a dispatcher?

YesNo

What do you already know about dispatching?

What are you hoping to learn?

4. Business Goals

Primary goal *

Dispatch my own truckStart a dispatch businessBothNot sure

Business name

Desired income-start timeline

LLC status

EIN status

5. Knowledge Level

DAT load board

Truckstop load board

Rate confirmations

Broker calls

6. Your Goals

What is the ONE thing you are most confused or nervous about?

What does success look like 90 days after this class? *

Anything else you want LeSheye’ to know?

Your answers will be placed into an email addressed to rawchaosdispatch@gmail.com.

Your email app should open now. If it does not, email your answers to rawchaosdispatch@gmail.com.

Raw Chaos Dispatching & Logistics · 470.974.0710