District 622 Special Transportation Order

Special Transportation Order

Transportation Department
Session*
Order Type*

NEW STUDENTCHANGEWITHDRAWALMcKinney-VentoFoster Care (Please put County in Notes)
Start Date*

MonthDayYear
(Use today's date if change is needed as soon as possible, otherwise enter a future start date)
End Date*

MonthDayYear
(Enter the last day service is needed.)
Case Manager Name*
Case Manager Email*
Form Entered By
(Not required, only needed if different from Case Manager above)
Form Entered By Email
(Not required, only needed if different from Case Manager above)
Student Information
Student Name*

First NameLast Name
Student ID #*
Grade*
Student Date of Birth*
Transportation Requested Due To*
Primary Disability*

AutismBlind / Visual ImpairedDeaf / Hard of HearingDevelopment Cognitive DisabilityEmotional Behavior DisorderOther Health DisabilityPhysical / Health ImpairedSeverely Multiply ImpairedSpecific Learning ImpairmentSpeech & Language ImpairedTemporary InjuryTraumatic Brain InjuryOther
Guardian & Emergency Contacts
Guardian 1*

First NameLast Name
G1 Home Phone*
G1 Cell Phone
G1 Email
example@example.com
Guardian 2

First NameLast Name
G2 Home Phone
G2 Cell Phone
G2 Email
example@example.com
Alternate Emergency Contact*

First NameLast Name
Emergency Phone 1*
Emergency Phone 2
Relationship to Student*
School Information
School Name*
Enter School Name
School Address
(#, Street, City, State, Zip)
School Start Time*

:HourMinutesAM/PM Option
School End Time*

:HourMinutesAM/PM Option
School Days - uncheck the days the student is not attending

MondayTuesdayWednesdayThursdayFriday
Student Transportation Addresses
Students Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Pick-up Location*

HomeAlternate AddressNone (Parent Transports)
Alternate Pick-up Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Alternate Address 1 Contact Person

First NameLast Name
Alternate Address 1 Phone
Student Drop-off Location*

HomeSame Alternate Address as Pick-upNew Drop-off Alternate AddressNone (Parent Transports)
Alternate Drop-off Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Alternate Address 2 Contact Person

First NameLast Name
Alternate Address 2 Phone
Student Transportation Accommodations
Student's Transportation Method:*

Dedicated SPED BusGeneral Ed BusSolo Vehicle (Must have pre-approval)
Student's Bus Stop Location:*

Specific AddressClosest CornerNeighborhood Bus StopStudent Lives Out of District - Assign Closest In-District Stop
Student's Special Equipment*

NoneWheelchair LiftBooster Seat (2nd Gr & Under if on Van)Safety Vest (Harness)Oxygen TankService Animal
Safety Vest Size:

XS: Ages 2-4 Waist 19-23"S: Ages 4-6 Waist 25-30"M: Ages 7-13 Waist 32-37"L: Ages 14-Adult Waist 37-42"
Student Height
Required for ECSE Students
Student Weight
Required for ECSE Students
Student's Supervision On-Vehicle:*

NoneAide/Monitor/ParaNurse
Student handling at school should be:*

Eye to Eye (Adult must be visible)Hand to Hand (Adult must be present at bus door)Student can be released with no supervision
Student handling at bus stop should be:*

Eye to Eye (Adult must be visible)Hand to Hand (Adult must be present at bus door)Student can be released with no supervision
Other Transportation Notes:
504 Plan Attachment

Browse Files

Cancelof
Select Special Services Supervisor for Approval:*
Supervisor Email
Supervisor Added Notes
Should be Empty:

Special Transportation Order

Student Information

Guardian & Emergency Contacts

School Information

Student Transportation Addresses

Student Transportation Accommodations