ISD 279 Open-Enrolled Student Transportation Request Form

When students are approved to attend a school outside their regular attendance area, transportation is the responsibility of the parent and/or legal guardian. However, transportation may be provided from an existing bus stop that serves the approved school under the following conditions: 1. Students are required to register each school year for the bus service and must be re-approved to use an existing bus stop annually. 2. Space must be available on the existing bus route to receive services. 3. Parents and students understand that they will be required to present themselves to the nearest bus stop in the attendance area of the school they are open enrolling into. Bus stops will not be available in non- enrollment areas. 4. Parents accept ultimate responsibility for ensuring that their students can get safely to and from the assigned bus stop. Bus stops may be further than normal eligibility criteria for bus stops because of open enrollment status.

Date Completed

Date

Staff Initials

I agree to the above conditions of the open enrollment transportation request . *

Yes No - I choose not to seek optional busing options for open enrollment busing service.

Student Information

Last Name *

First Name *

M.I. *

Birth Date *

Date

Gender

Grade *

E-mail Address

Open Enroll School of Attendance *

School Year *

Have you previously applied for Open Enrollment Bus Service *

Yes No

If Yes, What Year

2019-2020 2020-2021

Current Residence Information

Street Address *

City *

State *

Zip Code *

Home Phone Number

Cell Phone Number

Address Transportation is Requested From (If Different than Current Residence)

Street Address

City

State

Zip Code

Parent/Legal Guardian Certification (Agreement)

Last Name *

First Name *

By Checking the box below you agree that the information provided above is true and accurate. *

Agree

Comments & Questions

Please inform the office of any other vital information you think they may need to know regarding your request for open enrollment services.