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PRAIRIE ROSE SCHOOL DIVISION
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STUDENT TRANSPORTATION EXPENSE CLAIM
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Name of Parent/Guardian:
School of Attendance:
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Physical Address: Mailing Address:
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Name of Child(ren): Bus Route:
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Office Use Only
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Date (D/M/Y)KMS Traveled
One-Way		Trips per day
(Home to School = 1)		Total Daily KMAttendance
Confirmed		Home to School
Distance Confirmed
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 Mileage rate $ .40/KMTotal KMS0
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Total $ Claimed0
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Total $ Payable
(maximum $375)		 $
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Parent/Guardian Signature:
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Transportation Supervisor:
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Secretary Treasurer:
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Office Use Only
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