Okaloosa County BOCC — February 16, 2016 — Completed Application Final - 1-29-16

APPLICATION FOR OKALOOSA COUNTY TRAFFIC EDUCATION FUND DISBURSEMENTS AGENCY INFORMATION Okaloosa County Sheriff’s Office Agency Name: Okaloosa County School Board Program Name: Megan Warman Driver Education Safety Program Program Location: Various High Schools (name of school) Name/ Title of Agency School Board of Okaloosa County Contact: Address: 120 Lowery Place S.E. Phone: 850-833-5840 City • Zip Code: Fort Walton Beach, Florida 32548 E-mail: scallanr@mail.okaloosa.k12.fl.us New Renewal X Amount Program is: $ 63,156.54 Requested: PROPOSED PROGRAM INFORMATION 1. Program Summary (1-3 sentences): Provide an overview of program services. Funds will be used to enhance and expand the student education program in High Schools throughout Okaloosa County. 2. Proposed use of Okaloosa County Traffic Education Fund (1-3 sentences): Please identify the proposed use(s) of Okaloosa County Traffic Education Fund. These funds shall be used for direct educational expenses and shall not be used for administration. Specifically explain how these funds will be used for enhancement, and not replacement, of driver education program funds. See Attached Exhibit A. 1 Packet Pg. 328  Upon completing this Appl ication in its enti rety, please read the following statement and affix yo ur signature according ly. I have read , fully understand and agree to be bound by Section 318.1215, Florida Statutes, and Chapter 21 , Article V of the Okaloosa County Code of Ordinances (also known as Ordinance 11-17) as amended from time to time. I have completed this application fully and accurately and have not misrepresented any information contained herein. I certify that the requested funds will be used for the purposes set forth in this application and in conformity with applicable laws. Pursuant to Ordinance 11-17, I have submitted appropriate documentation of expenditures, programs, and other direct educational expenses along with this Application. I further agree that should I fail to provide any necessary follow-up documentation, I may be respon sible for reimbursing Okaloosa County for the amounts received. ~i:~eJo January 29, 2016 Date of Application Rita R. Scallan , CFO Print Name of Applicant OFFICIAL USE ONLY Board of County Comm issioners: Approved/Di sapproved Date: _ _ __ Amount approved: $._ _ __ 2 Packet Pg. 329  Okaloosa County School District Exhibit "A" Megan Warman Driver Education Safety Program Proposal