JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
SLUSD Transportation Form/Forma de Transporte/运输形式
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Today's Date/Fecha/今天的日期:
*
MM
/
DD
/
YYYY
Add or Change information/añadir o cambiar información/添加或更改信息:
*
Add/Agregar/添加
Change/Cambio/改变
Start date/Fecha de inicio/开始日期:
*
MM
/
DD
/
YYYY
Student Name- Last/Apellido del estudiante/学生姓氏:
*
Your answer
Student Name- First/Estudiante primero nombre/学生名字:
*
Your answer
Date of Birth/Fecha de nacimiento/出生日期:
*
MM
/
DD
/
YYYY
Grade/Grado/年级:
*
Your answer
Age/Años/年龄:
*
Your answer
AM Pickup Address/Dirección de recogida por la mañana/早上取货地址:
*
Your answer
PM Drop-off Address/Dirección de entrega por la tarde/下午下车地址:
*
Your answer
Parent/Guardian Name- Last/Apellido del padre o tutor/父母或监护人姓氏:
*
Your answer
Parent/Guardian Name- First/Nombre del padre o tutor/父母或监护人的名字:
*
Your answer
Parent/Guardian Address/Dirección del padre o tutor/父母或监护人地址:
*
Your answer
City, State, Zip Code/Ciudad, Estado, Código postal/城市, 状态, 邮政编码
*
Your answer
Parent/Guardian Phone Number/Número de teléfono del padre o tutor/父母或监护人电话号码
*
Your answer
Emergency Contact Name- Last/Apellido contacto de emergencia/姓氏紧急联系人
*
Your answer
Emergency Contact Name- First, Primer nombre contacto de emergencia/名字紧急联系人:
*
Your answer
Emergency Contact Phone Number/Número de teléfono contacto de emergencia/电话号码紧急联系人:
*
Your answer
School Attending/Asistir a la escuela/上学:
*
Choose
Garfield Elementary
Halkin Elementary
Jefferson Elementary
Madison Elementary
McKinley Elementary
Monroe Elementary
Roosevelt Elementary
Washington Elementary
Bancroft Middle School
John Muir Middle School
San Leandro High School
San Leandro Adult Transition
Other- NPS or SELPA school
School Address/Dirección de Escuela/学校地址:
*
Choose
Garfield- 13050 Aurora Dr, San Leandro, CA 94577
Halkin- 1300 Williams St, San Leandro, CA 94577
Jefferson- 14300 Bancroft Ave, San Leandro, CA 94578
Madison- 14751 Juniper St, San Leandro, CA 94579
McKinley- 2150 E 14th, San Leandro, CA 94577
Monroe- 3750 Monterey Blvd, San Leandro, CA 94578
Roosevelt- 951 Dowling Blvd, San Leandro, CA 94577
Washington- 250 Dutton Ave, San Leandro, CA 94577
Bancroft- 1150 Bancroft Ave, San Leandro, CA 94577
Muir- 1444 Williams St, San Leandro, CA 94577
SLHS- 2200 Bancroft Ave, San Leandro, CA 94577
Other- please indicate address in additional comments
Office Phone Number/Número de teléfono de la escuela/学校电话号码:
*
Choose
Garfield (510) 618-4300
Halkin (510) 618-4370
Jefferson (510) 618-4310
Madison (510) 895-7944
McKinley (510) 618-4320
Monroe (510) 618-4340
Roosevelt (510) 618-4350
Washington (510) 618-4360
Bancroft (510) 618-4380
Muir (510) 618-4400
SLHS (510) 618-4600
Other- please indicate number in additional comments
Check Any That Apply/Marque todo lo que corresponda/标记所有适用的:
Pre-K/Preescolar/学前班
ESY/Año escolar extendido/延长学年
Deaf Ed/Sordo/聋
Blind/Ciego/瞎的
Out of District/Fuera del distrito/区外
Medically Fragile/Médicamente frágil/医学上脆弱
Transportation Equipment Needs/Necesidades de equipo/设备需求
Wheelchair/Silla de ruedas/轮椅
Carseat/Asiento de coche/汽车座椅
Buckle Guard/Protector de cinturon/扣环
Booster/Asiento elevador/加高座椅
Special Monitoring/Monitoreo especial/专项监测
Harness- indicate size in additional comments (per IEP agreement)/Arnés- indicar talla en comentarios adicionales/线束 - 在附加评论中指明尺寸
Additional Comments/Comentarios adicionales/附加评论
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of San Leandro Unified School District.
Report Abuse
Forms
