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INDIAN RIVER COUNTY <br />DORI SLOSBERG DRIVER EDUCATION SAFETY ACT <br />GRANT PROGRAM REQUEST FOR FUNDING <br />SECTION A. APPLICANT INFORMATION <br />Identify the agency or organization and official who is authorized to execute any grant <br />related documents: <br />1. <br />Applicant Name: School District of Indian River County <br />2. <br />Address: 6500 57th Street <br />3. <br />Telephone Number: 7725643067 <br />�^,�Y;t�=f <br />E <br />4. <br />Authorized Official: Kelly Baysura <br />5. <br />Fiscal Officer: Ronald Fagan <br />E Z !� 1 <br />6. <br />Program Director: Kelly Baysura. <br />7. <br />Federal Identification Number: 596000673 <br />8. <br />Status: Public School <br />SECTION B. PROGRAM INFORMATION <br />1. Program Name: SDIRC Driver Education <br />2. Program Type: Curriculum <br />3. Total program budget: $49,000 <br />4. Amount of grant funds requested: $49,000 <br />5. List other and/or potential funding sources for the program and any matching <br />requirements <br />for such funds: <br />Funding Source: Amount: <br />NA <br />........... .......... ...... — - -..-...... . <br />6. Estimated number of students to be served: 110 <br />7. Cost per participant: $445.45 <br />SECTION C. CERTIFICATION - <br />I Agree - By checking the "I Agree" box and entering your name below, I do hereby <br />certify that all facts, figures and representation made in this application are true and <br />correct. Furthermore, all applicable statutes, regulations and procedures for program <br />compliance and fiscal control shall be implemented to insure proper accountability of any <br />grant funds awarded. I further certify that the funds requested in this application shall not <br />supplant funds that would otherwise be used for the purpose set forth in this application. <br />The filing of this application has been authorized by the Grant Applicant and I have been <br />duly authorized to act as the representative of the Grant Applicant in connection with this <br />application. <br />Kelly Baysura <br />Authorized Official's Name <br />Kelly Baysura <br />Name of Grant Applicant <br />227 <br />Date: 04/28/2021 <br />