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Okaloosa County BOCC — January 7, 2014 — Traffic Education Fund - application — reading text
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APPLICATION FOR OKALOOSA COUNTY
TRAFFIC EDUCATION FUND DISBURSEMENTS
AGENCY INFORMATION
Okaloosa County Sheriff’s Office
Agency Name:
Okaloosa County School Board
Program Name:
Program Location:
(name of school)
Name/ Title of Agency
Contact:
Address: Phone:
City • Zip Code: E-mail:
New Renewal Amount
Program is: P $
Requested:
PROPOSED PROGRAM INFORMATION
1. Program Summary (1-3 sentences): Provide an overview of program services.
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.
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Upon completing this Application in its entirety, please read the following statement and affix your
signature accordingly.
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 responsible for
reimbursing Okaloosa County for the amounts received.
Signature of Applicant Date of Application
Print Name of Applicant
OFFICIAL USE ONLY
Board of County Commissioners: Approved/Disapproved
Date: _________ Amount approved: $________
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