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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 related <br />documents: <br />1. Applicant Name: School District Indian River County <br />2. Address: 6500 57th Street, Vero Beach, FL. 32967 <br />3. Telephone Number: 772-564-3209 Fax: <br />4 <br />5 <br />6 <br />7 <br />Authorized Official: Anne Bieber <br />Fiscal Officer: Ronald Fagan <br />Program Director: Anne Bieber <br />Federal Identification Number: 596000673 <br />Status: Public School <br />SECTION B. PROGRAM INFORMATION <br />1. Program Name: School District Indian River County Driver Education <br />2. Program Type: Curriculum <br />3. Total program budget: $49,000.00 <br />4. Amount of grant funds requested: $49,000 00 <br />5. List other and/or potential funding sources for the program and any matching requirements <br />for such funds: <br />Funding Source: Amount: <br />Not Available $0.00 <br />Not Available <br />$0.00 <br />Not Available $0.00 <br />6. Estimated number of students to be served <br />7. Cost per participant: $445.45 <br />110 <br />EXHIBIT A <br />