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Special Education Transportation Application
**ONLY STUDENTS WHO REQUIRE TRANSPORTATION SERVICES BASED ON THEIR IEP QUALIFY FOR SPECIAL EDUCATION TRANSPORTATION**
This form is for Special Education students being transported within Beverly only. The Regular Education Application can be found on the
beverlyschools.org
website or through this link:
https://forms.gle/a6Qxoi7yDjp5HKCi9
The Out of District Special Education Application can be found through
beverlyschools.org
or through this link:
https://docs.google.com/forms/d/e/1FAIpQLScDnfOUcVHtMzIGEOX6IMg385i4n4QsmKzVbipxaimwa1Xmrg/viewform?usp=sf_link
If you would like to CANCEL or make any changes to your previously submitted application please email
Transportation@beverlyschools.org
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* Indicates required question
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Street Address
*
Your answer
Primary Phone
*
Example: xxx.xxx.xxxx
Your answer
Alternate Phone
Example: xxx.xxx.xxxx
Your answer
School
*
If your school is not listed here, please apply under the Out of District Application. See link above.
Ayers Ryal Side Elementary School
Centerville Elementary School
Cove Elementary School
Hannah Elementary School
North Beverly Elementary School
Beverly Middle School
Beverly High School
Mckeown Preschool
Grade
*
AM Pre-K
PM Pre-K
5 day Pre-K
Pre-K Speech/PT
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
SP
AM, PM, or Both Ways
*
Both Ways
AM Only
PM Only
Monitor Required
Yes
No
Clear selection
Special Instructions
Your answer
Requested Start Date
**ALL TRANSPORTATION REQUESTS WILL HAVE A 2 BUSINESS DAY WAITING PERIOD BEFORE TRANSPORTATION WILL BEGIN. THE 2 DAY PERIOD IS FROM THE DATE THIS FORM IS RECEIVED.***
MM
/
DD
/
YYYY
**IF YOUR CHILD IS PICKED UP OR DROPPED OFF SOMEWHERE OTHER THAN YOUR HOME ADDRESS, PLEASE PROVIDE THE FOLLOWING INFORMATION:
Daycare Provider Name
Your answer
Daycare Provider Address
Your answer
Daycare Provider Phone Number
Example: xxx.xxx.xxxx
Your answer
Days of the week at this location
Monday
Tuesday
Wednesday
Thursday
Friday
Pickup/Drop off times at this location
Morning Pickup
Afternoon Drop Off
Both
IF THE ABOVE INFORMATION IS NOT FILLED OUT, WE WILL PICK UP AND DROP OFF YOUR CHILD AT YOUR HOME 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
.
Your answer
If this form was completed by a liaison, please initial here.
Your answer
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