Kathy Stewart – Superintendent – (989) 399-SISD Jake Golden – Director of Operations – (989)799-1885 SAGINAW INTERMEDIATE SCHOOL DISTRICT TRANSPORTATION SERVICES REQUEST Requested by __________________________________

__ Date______________________

Student ____________________________________________Date of Birth_______________ UIC____________________________ Parent/Guardian ______________________________ Address ______________________________________________________________________ City _____________________________________

Zip Code____ _____________________

School District of Residence ____________________________ Phone ________________________ Emergency Phone _______________________________ Program ______________________ School Building _________________________________

Full Day

TRANSPORTATION NEEDED Half Day AM PM

Other

Starting Time ____________________ Dismissal Time _______________________________ Days Per Week M-F Other ______________________________________________________ Starting Date __________________ Wheel Chair Yes No

Safety Restraint Yes No

SPECIAL TRANSPORTATION REQUEST OR INFORMATION REGARDING STUDENT ------------------------------------SISD TRANSPORTATION--------------------------------------------P/U Location Time Bus # D/O Location Time AM

___________

_________

_______

____________

____________

Noon

___________

_________

_______

____________

____________

PM

___________

___________

_________

_______________

______________

For Office Use Only: Edulog ___ Route ___ Parent Contacted ____ Driver Copy ___CT______ Letter_______ C:\Users\kozuchk\Desktop\TRANSPORTATION SERVICES REQUEST.doc

TRANSPORTATION SERVICES REQUEST.pdf

Page 1 of 1. For Office Use Only: Edulog ___ Route ___ Parent Contacted ____ Driver Copy ___CT______ Letter_______.

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