Student Loss of School Bus Response

District

School

Grade

Student Last Name

Student First Name

Gender

Birth Date

Student ID

Alternate ID

Option 1: Indication of Use

"Regular use of a school bus" is a school bus rider who uses their assigned school bus at or more than 70% of the available school days in any given month.

I will regularly use the transportation assigned

Option 2: Excusable Reason Notice

I cannot use the bus on a regular basis and want permission to use the bus on a limited basis

Reason

Start Date

End Date

Submitted by I acknowledge that transportation procedures will apply.

Last Name

First Name

Student Loss of School Bus Response

More than one student matches the criteria submitted. Please select the student to use

Option 1: Indication of Use

Option 2: Excusable Reason Notice

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