Student Transportation Request Form - 2016-2017
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1Student Transportation Request Form
2016-2017
(NOTE: Magnet & Special Needs Transportation do not use this form. See your Coordinator/Case Manager.)
PARENT: Return this completed form to school office.
School Name (Print):________________________________________________________________________________
Student’s Name (Print): ________________________________________________________ Grade: ______________
Student’s Street Address (Print):______________________________________________________________________
Student’s City (Print): _______________________________________________
Zip: ______________________
Arrival Method:
Departure Method:
(Circle one)
(Circle one)
Car
(22)
Car
(22)
Walk / Bicycle
(33)
Walk / Bicycle
(33)
Regular Bus
(44)
Regular Bus
(44)
Day Care Bus
(99)
Day Care Bus
(99)
***Ridership status and/or bus stops are subject to cancellation after five (5) consecutive school days of
no ridership. If your child will be absent from bus service for more than five (5) days and you’d like to
keep their status active, please notify the school office. Students must ride at least once every five (5) days
in order to remain active. Parent’s Initial_____
***Requests received after July 31, 2016 will not be routed for the first day of school. Transportation for
late forms will be implemented in the order in which they were received by the Transportation Office
beginning September 6, 2016. After September 6, 2016 and during the school year, it may take up to 5
school days to establish transportation. Parent’s Initial_____
Parent/Guardian Name (Print): ______________________________________________________________________
Parent/Guardian Contact Numbers:
Phone__________________________________ (Number to receive automated messages/emergency/attendance info)
1.
2.
Phone _________________________________
_________________
Mom
Dad
Guardian
circle:
3.
Phone _________________________________
_________________
Mom
Dad
Guardian
circle:
To be completed by School Officials
Entered in PowerSchool: ___________ Employee initials: ____________ Date: ________________
School
***
: After entry in Powerschool, fax to appropriate Bus Center ONLY IF REGULAR BUS IS REQUESTED***
Bus Center
***
: Route within 3-5 school days - contact Parent/Guardian***
Rev. 11-18-15 dp/jp
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