UPPER SANDUSKY SCHOOLS
TRANSPORTATION DEPARTMENT
This form is for use when you are requesting an alternative stop location for your child.
As a safety consideration for your child it is important that the Transportation Department have current information. Medical and designated place of safety forms must be on file.
This form must be filled out every school year and returned to the Bus Garage 72 hours in advance.
I AM REQUESTING THAT THE FOLLOWING STUDENT BE TRANSPORTED TO/FROM AN ALTERNATIVE ADDRESS:
STUDENT NAME _________________________________ SCHOOL____________
HOME ADDRESS________________________________________ GRADE_______
ALTERNATIVE RESIDENCE NAME______________________________________
ALTERNATIVE ADDRESS ______________________________________________
ALTERNATIVE PHONE_________________EMERGENCY PHONE____________
DAYS OF WEEK: MON_____ TUES_____WED_____THURS_____FRID_____
AM_____ PM_____ BOTH_____
DATES TRANSPORTATION REQUESTED: FROM____________ TO___________
PARENT/GUARDIAN SIGNATURE________________________________________
THIS REQUEST WILL BE APPROVED IF THE ALTERNATIVE STOP IS ON A BUS RUN AND THE STOP WILL BE CONSISTENT AND SPACE IS AVAILABLE.
THIS SECTION FOR COMPLETION BY THE TRANSPORTATION DEPARTMENT
REGULAR BUS NUMBER ASSIGNED AM _____ PM _____
ALTERNATIVE BUS NUMBER ASSIGNED AM _____ PM _____
APPROVED BY: __________________________________ DATE _______________