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SAFE Program Check Request Form

Check Information
Shipping Information

Please enter the shipping information for where the check should be mailed, in the fields provided below.

Local Donors

List all donors and/or diversion dollars that have been secured.

 
Name
Amount
Total Funds:
Expenses

Example: $25 x (1/100 x Number of Students Participating) x Number of Months Participating

 
Description
Amount
($25 x 1/100 x Number Of Students Participating x Number Of Months Participating) + (Other Expenses - Total Donor Funding) = Total Funding Requested:

All or a portion of the requested funding will be awarded. Other requests will be evaluated on February 1st and awarded based on availability of funds.

I understand by submitting this form and requesting a grant from the Oklahoma Highway Safety Office, I have committed to implement the SAFE program to its completion. Submitting the final survey marks completion of the program. Failure to complete the program will result in returning the grant dollars received. By typing your name and entering the date in the fields provided, you are signing this agreement.

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