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EXHIBIT A <br />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. Applicant Name: School District of Indian River County <br />2. Address: 6500 57th Street <br />3. Telephone Number: 772-564-3014 Fax: <br />4. Authorized Official: Kelly Baysura <br />5. Fiscal Officer: Ronald Fagan <br />6. Program Director: Kelly Baysura <br />7. Federal Identification Number: 596000673 <br />8. Status: Public School <br />SECTION B. PROGRAM INFORMATION <br />1. Program Name: Drivers Education <br />2. Program Type: Curriculum Programming <br />3. Total program budget: $49,000.00 <br />4. Amount of grant funds requested: $49,000 0n <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 $0.00 <br />$0.00 <br />$0.00 <br />6. Estimated number of students to be served: 98 <br />7. Cost per participant: $500.00 <br />EXHIBIT A <br />