HS Trips: Julie Schlereth #3409

Elem/MS Trips: Rich Maionchi #3411

C.U.S.D. 95 - TRANSPORTATION REQUEST FORM

Instructions: 1) Requests MUST be submitted a minimum of 3-1/2 weeks prior to the trip.
2) A separate request form must be submitted for each trip and date.
3) All stops that the bus will be expected to make must be specified on this request form
4) Trips are assigned in the order of receipt based on availability.
5) A copy will be returned to you by the Transportation office approximately 2 weeks prior to the trip with the bill.
6) You will be asked to sign the trip release with the release time at the bottom of the form at the conclusion of your trip.

Date of Trip: Week DayChoose one # of Students: # of Adults:

Pick up Location: Choose one Door #

Destination: Phone:

Street: City: Field Location/Campus:

Departure time from school: AM PM Event Starts: AM PM

Estimated Departure Time From Destination: AM PM

Teacher/Coach: Cell Phone:

Grade/Class/Team:
Please explain correlation to curriculum:

Special Instructions (directions, parking, food stops, or add’l stops):

Special Needs: White Activity Bus Wheelchair Bus Harness Star Seat Other
Approved By: Principal: Asst. Principal: Date:
Asst. Superintendent - Student Svcs:
Trip To Be Paid For By: School Special Ed Transportation Other

(TRANSPORTATION OFFICE USE ONLY)

# of Buses:________ Driver 1: ________________________ Driver 2: __________________________

Driver 3: ________________________ Driver 4: _________________________

Driver Check-In Time: __________AM/PM Actual Departure Time From School: _______AM/PM

START MILEAGE (mileage @ pick-up location) _______ END MILEAGE (mileage at final drop location) ________

TRIP RELEASE – HAVE YOU CHECKED THE BUS FOR LOST ARTICLES AND DAMAGE?
Teacher’s/Coach’s Signature:__________________________________________ Time:__________am/pm
Comments:______________________________________________________________________________
Driver Check-Out Time:_______________________AM/PM

OFFICE USE ONLY

Handout Work in Assignment Posted Invoiced Date Recd By Trans:

Document1Last printed 8/1/2018 9:09 AM