Administrative Form 7576 Annual Request To Transport Students printable pdf download

Administrative Form 7576

PLEASE SUBMIT FORM TO:

ANNUAL REQUEST

TRANSPORTATION DEPARTMENT

EXCURSIONS – SOUTH YARD

TO TRANSPORT STUDENTS

Phone: 775-337-7706 Fax: 775-851-5609

Approval must be granted each year to all drivers who transport students (other than the driver’s own children). This includes school district

employees who may operate any motor vehicle owned, leased, rented or otherwise obtained using WCSD funds to transport students. (Note:

Full insurance must be purchased when renting or leasing a vehicle) Specific requirements and restrictions are defined in WCSD

Administrative Regulation 7545.2. Please read all instructions carefully before signing this request. Applicants may not transport students

unless they have an approved copy of this form in their possession. Please allow one (1) week for transportation to process this request.



ONLY SCHOOL DISTRICT EMPLOYEES MAY DRIVE WCSD OWNED/LEASED/RENTED VEHICLES



PRIVATE VEHICLES MAY NOT BE USED BY ANY DRIVER TO TRANSPORT STUDENTS OUT OF THE STATE

OF NEVADA WITH THE EXCEPTION OF THE LAKE TAHOE BASIN, TO INCLUDE THE TRUCKEE/DONNER

PASS AREAS, EXCEPT TO TRANSPORT THE DRIVER’S OWN CHILDREN.

DRIVER’S NAME

: ____________________________________

________________________

SCHOOL/DEPT:

THE DOCUMENTS LISTED BELOW ARE REQUIRED TO PROCESS THIS APPLICATION:

DISTRICT EMPLOYEES:

(Please check if this application is for a district employee)

A current copy of your WCSD Identification card.

A printout of your 10 year Nevada DMV record provided from a state DMV office, requested within the last 30 days. (Please

note: only one 10 year DMV printout is required per school year. A violation code of 400 and above will result in an automatic

denial. If you have not had a license in NV for 10 years, a copy of the previous state’s 10 year driving record and your 10

year NV DMV record must be attached.)

IF YOU WILL DRIVE A PRIVATELY OWNED VEHICLE: A printout of your current auto insurance declaration page

including liability limits. (Limits below $100,000/300,000 will be denied).

IF YOU WILL DRIVE A DISTRICT VEHICLE: A copy of your WCSD issued Defensive Driving Certificate.

VOLUNTEERS:

(Please check if this application is for a Volunteer)

A printout of your 10 year Nevada DMV record provided from a state DMV office, requested within the last 30 days. (Please

note: only one 10 year DMV printout is required per school year. A violation code of 400 or above will results in automatic

denial. If you have not had a license in NV for 10 years, a copy of the previous state’s 10 year driving record and your 10

year NV DMV record must be attached.)

IF YOU WILL DRIVE A PRIVATELY OWNED VEHICLE: A printout of your current auto insurance declaration page

with liability limits. (Limits below $100,000/300,000 will be denied).

A copy of your “approved” volunteer application, to include background check/fingerprinting.

I certify that the information provided is current and correct to the best of my knowledge. I also understand that this approval, if granted,

will expire at the end of the current school year or the date of expiration for the attached insurance declaration or driver’s license, whichever

expires first.

SIGNATURE OF DRIVER: _____________________________________________DATE: ____________________

ADMINISTRATOR’S CERTIFICATION

PLEASE MARK ONE OR BOTH OF THE FOLLOWING STATEMENTS AS APPROPRIATE:

( ) I certify that this volunteer is approved, by me, to use a private vehicle to transport students for trips within the state of Nevada, Lake

Tahoe Basin and Truckee area.

( ) I certify that this district employee is approved, by me, to transport students in a District vehicle within the parameters of the

Transportation Department or leased/rental vehicles or private vehicles for trips as needed.

ADMINISTRATOR’S SIGNATURE: _____________________________________ DATE: ______________________

TRANSPORTATION USE ONLY BELOW THIS LINE

DATE RECEIVED: ______________________________ EXPIRATION DATE: _____________________________

INSURANCE EXP.: ______________________________

NVDL EXP.:_________________________________

v2, 7/01/2015

REQUEST IS:

APPROVED: _____ DENIED: _____

REASON: _______________________________

DIRECTOR OF TRANSPORTATION: _________________________________________________________________

Administrative Form 7576 Annual Request To Transport Students

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