Drive to Succeed Application

'Drive to Succeed' is an Ohio grant-funded program to help teens complete driver training at an affordable cost! In Greene County, eligible students will be determined by age, financial need, a recommendation letter, and essay submission. Applications will be reviewed by members of the Greene County Safe Communities Coalition. Driver's education scholarships will be for in-person classroom instruction and behind-the-wheel training through select driving schools. Applicants are responsible for paying a $50 fee to the identified school. For more information on the school choices, please contact Loressa Gonyer at lgonyer@gcph.info or (937) 374-5655. Scholarships will be available as long as grant funding lasts.

You will receive notification from Greene County Public Health regarding your successful application. Questions? Please contact Loressa Gonyer.

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* 1. What is your full name as it appears on your birth certificate?

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* 2. What is your date of birth?

Date / Time

Date

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* 3. Please provide your contact information.

Address *

Address 2

City/Town *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 4. What is your preferred contact method?

Phone

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* 5. Please provide your legal guardian's contact information.

Name *

Address *

Address 2

City/Town *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 6. What high school do you attend?

Beavercreek High School

Bellbrook High School

Cedar Cliff High School

Fairborn High School

Greene County Career Center

Greeneview High School

Legacy Christian Academy

Xenia High School

Yellow Springs High School

Other (please specify)

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* 7. Do you have your Driver's Permit?

Yes

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* 8. Do you agree to complete 24 hours of classroom instruction and 8 hours of behind-the-wheel instruction at one of our partner schools?

Yes

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* 9. Will you face any barriers (lack of transportation, etc.) to attending in person drivers' education?

Yes

If you answered yes, please explain.

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* 10. Applicants are required to provide confirmation that they have not yet received teen driver training. Please upload an affidavit signed by the parent or guardian confirming this.

An affidavit can be found on Greene County Public Health's website or here (https://www.gcph.info/wellness-services/chronic-disease-injury-prevention/safe-communities)

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* 11. Please provide proof of your financial need. Financial need may be identified by reduced/free lunch eligibility, WIC/SNAP eligibility, Medicaid recipient, or by the poverty guidelines set forth by the Department of Health and Human Services. A link to a table that shows the guidelines can be accessed here. Financial need will be determined by total number of household occupants at 150% of the federal poverty level.

If a student is not currently receiving a free/reduced, WIC/SNAP benefits, Medicaid, or does not meet the poverty guidelines, but experiences a financial hardship (decrease in household income, student or family
member become unemployed, have an increase in household size, etc.) they may still be considered for the Drive to Succeed scholarship based upon a written statement of financial need. Upload document or written statement.

Acceptable documents include Medicaid card, written statement from employer(s), pay stub, WIC/SNAP documents/card, etc.

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* 12. Applicants are required to provide one letter of recommendation from a Teacher, Coach, School Resource Officer, school administrator, or someone who can describe your skills, personality, and accomplishments. Letter of recommendations should not come from relatives. Please upload the letter of recommendation.

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* 13. Why is the Drive to Succeed Scholarship important to you? Please provide a short essay (500 words or less) to convince the scholarship review committee why you deserve the scholarship over other eligible applicants. Responses should consist of information beyond financial need.

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* 14. Are you aware that scholarship recipients are required to pay $50 to the partnered school? More information will be provided upon notification of award.

Yes