Special Transportation Order
Transportation Department
Session
*
SY 2024-25
SY 2025-26
Order Type
*
NEW STUDENT
CHANGE
WITHDRAWAL
McKinney-Vento
Foster Care (Please put County in Notes)
Start Date
*
/
Month
/
Day
Year
(Use today's date if change is needed as soon as possible, otherwise enter a future start date)
End Date
*
/
Month
/
Day
Year
(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 Name
Last Name
Student ID #
*
Grade
*
ECSE
Pre-K
KG
01
02
03
04
05
06
07
08
09
10
11
12
12+
Student Date of Birth
*
Transportation Requested Due To
*
Special Ed (IEP)
Early Childhood Special Ed
Care & Treatment
504 Plan
Mckinney-Vento
Foster Care
Primary Disability
*
Autism
Blind / Visual Impaired
Deaf / Hard of Hearing
Development Cognitive Disability
Emotional Behavior Disorder
Other Health Disability
Physical / Health Impaired
Severely Multiply Impaired
Specific Learning Impairment
Speech & Language Impaired
Temporary Injury
Traumatic Brain Injury
Other
Guardian & Emergency Contacts
Guardian 1
*
First Name
Last Name
G1 Home Phone
*
G1 Cell Phone
G1 Email
example@example.com
Guardian 2
First Name
Last Name
G2 Home Phone
G2 Cell Phone
G2 Email
example@example.com
Alternate Emergency Contact
*
First Name
Last Name
Emergency Phone 1
*
Emergency Phone 2
Relationship to Student
*
School Information
School Name
*
Carver
Castle
Cowern
Eagle Point
Justice Allen Page
Oakdale
Richardson
Skyview ES
Weaver
John Glenn MS
Maplewood MS
Skyview MS
North HS
Tartan HS
Beaver Lake
Gladstone
Flex
Webster Education Center
Next Step
916 Career & Tech
916 Pankalo
916 Karner Blue
916 Quora
916 South Campus
916 Bellaire
916 Wels-North
916 Wels-South
Fairview Maplewood
Fairview Riverside
Anthony Lewis
Aris
Nets
Options Roseville
TEC Oakdale
TEC Webster Education Center
TLC Oakdale
Prairie Care Maplewood
Prairie Care Woodbury
Prairie Care Brooklyn Park
Prairie Care Edina
United Hospital
Other Not Listed
Enter School Name
School Address
(#, Street, City, State, Zip)
School Start Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
05
10
15
20
25
30
35
40
45
50
55
Minutes
AM
PM
AM/PM Option
School End Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
05
10
15
20
25
30
35
40
45
50
55
Minutes
AM
PM
AM/PM Option
School Days - uncheck the days the student is not attending
Monday
Tuesday
Wednesday
Thursday
Friday
Student Transportation Addresses
Students Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Pick-up Location
*
Home
Alternate Address
None (Parent Transports)
Alternate Pick-up Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Alternate Address 1 Contact Person
First Name
Last Name
Alternate Address 1 Phone
Student Drop-off Location
*
Home
Same Alternate Address as Pick-up
New Drop-off Alternate Address
None (Parent Transports)
Alternate Drop-off Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Alternate Address 2 Contact Person
First Name
Last Name
Alternate Address 2 Phone
Student Transportation Accommodations
Student's Transportation Method:
*
Dedicated SPED Bus
General Ed Bus
Solo Vehicle (Must have pre-approval)
Student's Bus Stop Location:
*
Specific Address
Closest Corner
Neighborhood Bus Stop
Student Lives Out of District - Assign Closest In-District Stop
Student's Special Equipment
*
None
Wheelchair Lift
Booster Seat (2nd Gr & Under if on Van)
Safety Vest (Harness)
Oxygen Tank
Service 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:
*
None
Aide/Monitor/Para
Nurse
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
Cancel
of
Select Special Services Supervisor for Approval:
*
Jill Kenton
Dan Stang
Kayla Campanelli
Marvin Sims
Amber Zimmer
Tricia St. Michaels
Julie Drews
Stephanie Lindekugel (Shannon Lippke)
Submit for Approval
Supervisor Email
Supervisor Added Notes
Should be Empty: