TAYLOR AWARD FORM

Driver education can help reduce traffic crashes by improving driving skills and decision making. This award contributes to the well-being of all drivers in Allen County. Applications must be completed online by June 30, 2022, at 11:00 pm. Questions or comments can be directed to (260) 494-0728.

(Please include applicant)

Additional financial information:
If there are unusual circumstances regarding your financial information provided or if there are unusual financial circumstances expected in the future, please provide an explanation below.

SCHOOL ACTIVITIES

VOLUNTEER SERVICE ACTIVITIES AND EMPLOYMENT HISTORY

CERTIFICATION and DISCLOSURE OF INFORMATION

Your acceptance of the terms set forth below is required for your participation in the Drive Alive Taylor Memorial Award for Drivers Education.

To indicate your acceptance of these terms, you must enter your signature where indicated below.

I certify that all information on this form is true and complete to the best of my knowledge. If asked by any authorized official of Drive Alive, I agree to give documentation for information given on this form. I realize that this proof may include a copy of a U.S. tax return.

The information that I have reported on this application is, to the best of my knowledge, true and correct. I have accurately recorded my activity involvement and financial information. I understand that incorrect or incomplete information could jeopardize consideration of this application.

(If under age 18) I certify that I have shared the contents of this online application with my parent or guardian and he/she has granted permission for my participation in the Drive Alive Taylor Memorial Award program.

Should I win the award, I agree to contact and schedule my driver education course with the course provider within six months of winning the award.

By entering my name below, I officially indicate my agreement and give my consent to all of the above terms and conditions of the Drive Alive Taylor Memorial Award.

PARENT CERTIFICATION
Parental participation in the Drivers Education process is essential. From simply transporting the student to the education course to setting a good example in their own driving behaviors, parents play an important role in becoming a successful young driver.

If you accept the following conditions of the award program, please indicate your acceptance by checking each box.

By entering my name below, I officially indicate my agreement and give my consent to all of the above terms and conditions of the Drive Alive Taylor Memorial Award for Drivers Education.

P: 260.494.0728
E: info@drivealiveindiana.org
P.O. Box 80053
Fort Wayne, Indiana 46898-0053

2022 TAYLOR AWARD

Taylor Memorial Award for
Drivers Education Application

Student Information

Family Information

Children of Parents

Other Dependents of Parents

Financial Information

School and Community Activities

Student Essay

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