Only drivers education providers are eligible to enroll in the program. Individual students that meet all requirements are encouraged to engage providers in their area.
I,
, am interested in participating in the
Eisenhower Legacy Transportation Program Driver Education Reimbursement Grant
and certify I meet all requirements listed in the Kansas Department of Education guidelines.
I am registering for a:
A public school
A commercial driver education school
School Name
Unified School District #
Federal Employer Identification Number
Data Universal Numbering System #
System for Award Management # Expiration Date
School Year
2020-2021
2021-2022
2022-2023
Semester
Fall
Spring
Summer
Commercial School Name
License #
Federal Employer Identification Number
Data Universal Numbering System #
System for Award Management # Expiration Date
Class start date
Class end date
# of Eligible Students
Program Cost Per Student
Total Reimbursement Amount Requested
*Reimbursement can’t exceed $200 per eligible student
Primary Contact
First Name
Last Name
Street Address
City
State
Postal Code
Email Address
Phone#
Financial Contact
First Name
Last Name
Email Address
Phone#
I certify the “eligible students” were verified by this entity as meeting the program requirements.
Provider agrees to keep “eligible student” records for up to five (5) years in case of KDOT audit.
Contact Person Signature
Date of Submission
