Out of District Special Education Transportation Application
**ONLY STUDENTS WHO REQUIRE TRANSPORTATION SERVICES BASED ON THEIR IEP QUALIFY FOR SPECIAL EDUCATION TRANSPORTATION AND ARE BEING TRANSPORTED OUT OF DISTRICT**

This form is for Special Education students only. The Regular Education Application can be found on the beverlyschools.org website or through this link: https://docs.google.com/forms/d/e/1FAIpQLSeqDLny4_d15kmDpn0dhHEJPv2dgI6L_ZN8DDRRLBxHC9H1eg/viewform

The Special Education Application for Special Education students being transported within Beverly can be found here: http://beverlyschools.org/resources/transportation/Special_Education_Transportation_Application
Student's First Name *
Student's Last Name *
Street Address *
Primary Phone *
Example: xxx.xxx.xxxx
Alternate Phone
Example: xxx.xxx.xxxx
School Name and Address *
Grade *
AM, PM, or Both Ways *
Monitor Required
Clear selection
Special Instructions
Requested Start Date
MM
/
DD
/
YYYY
IEP Signed by Parent/Guardian
MM
/
DD
/
YYYY
**ALL TRANSPORTATION REQUESTS WILL HAVE A 2 DAY WAITING PERIOD BEFORE TRANSPORTATION WILL BEGIN. THE 2 DAY PERIOD IS FROM THE DATE THIS FORM IS RECEIVED.***
**IF YOUR CHILD IS PICKED UP OR DROPPED OFF SOMEWHERE OTHER THAN YOUR HOME ADDRESS, PLEASE PROVIDE THE FOLLOWING INFORMATION:
Daycare Provider Name
Daycare Provider Address
Daycare Provider Phone Number
Example: xxx.xxx.xxxx
Days of the week at this location
Pickup/Drop off times at this location
IF THE ABOVE INFORMATION IS NOT FILLED OUT, WE WILL PICK UP AND DROP OFF YOUR CHILD AT YOUR HOME ADDRESS
Parent/Guardian Email Address:
Parent/Guardian Signature (Typed) *
By signing this, we verify that we have read the Terms and Conditions for Bus Riding Privileges and agree to do all that we can to see that our child complies with bus rules. Find the Terms and Conditions here: https://drive.google.com/file/d/1HSegJDoH2qjchLVXzxdEdjAATuj_hLCr/view?usp=sharing
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