Request for Special Education Transportation for the 2020-2021 School Year
If your child's IEP has special transportation listed as a related service, please complete this form to request transportation services for the 2020-2021 school year.
* Required
Student Name
*
Your answer
Grade Level
*
Choose
EC/Prek
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
What school will your child attend?
*
Choose
Henning EC/Pre-k AM
Henning EC/Prek PM
Henning Elementary
Silver Creek Elementary
St. Jacob Elementary
Marine Elementary
Triad Middle School
Triad High School
Educational Therapeutic Center (ETC)
Logos
William BeDell
Illinois Center for Autism
Central Institute for the Deaf
Menta Academy
Moog School for the Deaf
Great Circle
Coordinated Youth
Home Address
*
Your answer
Cell Phone Number (xxx-xxx-xxxx)
*
Your answer
Alternate Phone Number (xxx-xxx-xxxx)
*
Your answer
Parent email address
*
Your answer
School Hours
*
Choose
Full Day
AM Only
PM Only
Start Date
*
MM
/
DD
/
YYYY
Pick up Address if Different than Home Address
Your answer
Pick up Phone Number if Different than Home NUmber (xxx-xxx-xxxx)
Your answer
Drop Off Address if Different than Home Address
Your answer
Drop Off Phone Number if Different than Home Number (xxx-xxx-xxxx)
Your answer
Transportation Accommodations
*
Walks Unassisted
Walks with Assistance
Uses Wheelchair
Requires 5-Point Safety Restraint
Requires a Car Seat
Other
Emergency Contact Other than Parent
*
Your answer
Emergency Contact Phone Number (xxx-xxx-xxxx)
*
Your answer
Second Emergency Contact
Your answer
Emergency Contact 2 Phone Number (Use xxx-xxx-xxxx format)
Your answer
My Child has Health Concerns
Yes
No
Clear selection
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