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