Transportation Request Form 2020
Please keep in mind that a student may have one bus stop in the morning and one stop in the afternoon. These stops do not have to be the same (i.e., the student can be picked up in the morning from his home and then dropped off in the afternoon at a childcare provider's location). If alternative arrangements need to be made because of a custody issue, the Transportation Department will need a copy of the pertinent pages of the custody order to honor such arrangements.
Email address *
STUDENT INFORMATION
Student's Name *
School Building Student will Attend in 2020-2021 *
Student's Grade for the 20-21 School Year *
PARENT/GUARDIAN INFORMATION
Parent/Guardian Street Address (street, city, state, zip code) *
Parent/Guardian Telephone Number *
CHILDCARE PROVIDER INFORMATION
Name of Childcare Provider *
Childcare Provider's Home Address (street, city, state, zip code) *
Childcare Provider Telephone Number *
MORNING PICK-UP LOCATION (transportation to school)
Morning pick-up location (home or Childcare Provider) *
Morning Bus Stop (actual bus stop location/address) *
AFTERNOON DROP-OFF LOCATION (transportation from school)
Afternoon drop-off location (home or childcare provider) *
Afternoon Bus Stop (actual bus stop location/address) *
EARLY DISMISSAL DAYS
On early dismissal days, my child should be transported to: *
SIGNATURE / DATE
Signature (Name of individual submitting this request *
Effective Date *
MM
/
DD
/
YYYY
PLEASE NOTE: This request can only be approved by the Transportation Office, and should be completed by June 1, 2020. If you have any questions, or need additional information, please call 717-382-4843, ext. 6229, or send an e-mail to waltimyerp@sesd.k12.pa.us.
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