Driver Education Application For Prior Year Reimbursement Form

Download a blank fillable Driver Education Application For Prior Year Reimbursement Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Driver Education Application For Prior Year Reimbursement Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

DRIVER EDUCATION APPLICATION FOR PRIOR YEAR REIMBURSEMENT
The Application for Prior Year Reimbursement is due by October 15.. (The mailing envelope MUST BE POSTMARKED by the United States
Postal Service [USPS] before/on October 15). Please submit the completed ORIGINAL APPLICATION WITH SIGNED ROSTERS to:
Oklahoma State Department of Education (SDE), State Aid Section, 2500 North Lincoln Boulevard, Oklahoma City, Oklahoma 73105-4599. Retain
a file copy. Applications not received or postmarked by the October 15 deadline are subject to nonpayment.
County No. __________
County Name __________________________________________________________
Reimbursement is for
School Year: ___-___
District No. __________
District Name __________________________________________________________
This form completed by:
Title:
Phone: (
)
Driver Education (DE) courses eligible for reimbursement must:
(a) Have an ending date on/between July 1 – June 30
(b) Have an Instructor Certification, Assurances, and Permit (ICAP) form, approved prior to the course, on file with the State Aid Section of the
SDE for each course taught by a certified instructor.
INSTRUCTIONS
(1) Enter the beginning and ending date (month-date-year) of each driver education course within the appropriate semester.
(2) Enter only the number of students who passed a driver education course (30 hours of classroom instruction and 6 hours behind-the-wheel
instruction) as verified by documented final student grades. Include all sites for your district in each semester total. You may not count the
same student more than once. If a student is counted in the category of “before school” total, he/she cannot be counted in the “after school”
total.
(3) Multiply the number of students (in each semester/session) by the state reimbursement amount on lines 1 through 8.
Summer Session I
Beginning date _______________
Ending date _______________
$ ________________
Number of students who passed: _________ multiply (x) $82.50 (amount per student) . . . . . . . . . . .
1.
Semester I (Fall)
Beginning date _______________
Ending date _______________
Beginning date _______________
Ending date _______________
For all courses during the regular school day, enter the total:
Number of students who passed: _________ multiply (x) $82.50 (amount per student) . . . . . . . . . . .
2.
$ ________________
For all courses before the regular school day, enter the total:
Number of students who passed: _________ multiply (x) $95.00 (amount per student) . . . . . . . . . . .
3.
$ ________________
For all courses after the regular school day, enter the total:
Number of students who passed: _________ multiply (x) $95.00 (amount per student) . . . . . . . . . . .
4.
$ ________________
Semester II (Spring)
Beginning date _______________
Ending date _______________
Beginning date _______________
Ending date _______________
For all courses during the regular school day, enter the total:
Number of students who passed: _________ multiply (x) $82.50 (amount per student) . . . . . . . . . . .
5.
$ ________________
For all courses before the regular school day, enter the total:
Number of students who passed: _________ multiply (x) $95.00 (amount per student) . . . . . . . . . . .
6.
$ ________________
For all courses after the regular school day, enter the total:
Number of students who passed: _________ multiply (x) $95.00 (amount per student) . . . . . . . . . . .
7.
$ ________________
Summer Session II
Beginning date _______________
Ending date _______________
Number of students who passed: _________ multiply (x) $82.50 (amount per student) . . . . . . . . . . .
8.
$ ________________
0.00
Add all totals in the right column, lines 1 through 8. The estimated total district reimbursement is . . . . . .
9.
$
I hereby certify the information in this document is complete and accurate. Student count and course grades have been verified by the
instructor(s) to the superintendent and/or principal. All courses were completed between July 1 and June 30.
Superintendent’s Signature: ___________________________________________________________________ Date: _____________________
I hereby certify the information in this document is complete, accurate, and reconcilable with all school records. This school district is in
compliance with all Oklahoma rules, regulations, and statutes regarding the scope of Driver Education.
NOTE: Staff of the State Department of Education is responsible for obtaining the signature below.
Regional Accreditation Officer’s Signature: ______________________________________________________ Date: _____________________

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go