DRIVER EDUCATION APPLICATION FOR PRIOR YEAR REIMBURSEMENT
The Application for Prior Year Reimbursement is due by September 1. (The mailing envelope MUST BE POSTMARKED by the United
States Postal Service [USPS] before/on September 1). 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
or email to state.aid@sde.ok.gov. Retain a file copy. Applications not received or postmarked by the September 1 deadline are subject to
non-payment.
County No. __________ County Name __________________________________________________________ Reimbursement is for
School Year: ___-___ School Year: 2001-02
District No. __________ District Name __________________________________________________________
This form completed by: Title: Phone: ( ) 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. $ ________________
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: _____________________
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