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EXHIBIT <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 of Indian River County <br /> 2. Address: 6500 57th Street, Vero Beach, FL 32967 <br /> 3. Telephone Number: 772-564-3209 Fax: <br /> 4. Authorized Official: Anne Bieber <br /> 5. Fiscal Officer: Bruce Green <br /> 6. Program Director: Anne Bieber <br /> 7. Federal Identification Number: 596000673 <br /> 8. Status: Public School <br /> SECTION B. PROGRAM INFORMATION <br /> 1. Program Name: School District of 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 <br /> requirements <br /> for such funds: <br /> Funding Source: Amount: <br /> $0.00 <br /> $0.00 <br /> $0.00 <br /> 6. Estimated number of students to be served: 110 <br /> 7. Cost per participant: $445.45 <br /> EXHIBIT A <br />