Special Education Transportation Request Form

Fill in all entries marked with an asterisk (*) so that your information can be correctly processed. To submit this form you must click 'send' at the bottom of the page.

Board of Education* School Year

Check One*

First Name* Last Name* M.I.

Sex* Date of Birth*

Parent or Guardian*

Active Phone Number*

Exact Location (Necessary for transportion directions)

Street Address* Town*

Mailing Address

Street Address* Town*


Emergency Phone*

Contact Person* Relationship

School to be Attended*

School Address*

School Phone* Grade

Approximate Mileage to the School

Starting Date*

Hours in School* to

Classification* Bus Aide Required*

(Example: Subject to Seizures, Allergies, Medications, Recommendations to ensure safe transportation)

IMPORTANT! Must be completed if applicable!

Confined to a Wheelchair
Type of Chair

Car Seat Required

Harness Required