Student Transportation Request Form
Ithaca City School District (ICSD) will be responsible for providing transportation for students between school and either their home or an identified alternate day care provider only. The day care must be located within ICSD boundaries and be a licensed or registered day care provider. Open Enrolled students are not provided ICSD Transportation. See ICSD Board Policy 8400 for additional information about transportation. http://go.boarddocs.com/ny/icsd/Board.nsf/goto?open&id=A53NUH61A143
Morning Pick-Up Location
Monday
Tuesday
Wednesday
Thursday
Friday
Afternoon Drop-Off Location
Morning Day Care
Afternoon Day Care
Provider Name
Provider Address
Provider Phone Number
Changes to Transportation Plan:
* Emergency & one-time changes in pick-up/drop-off locations - Contact school
* Changes to schedule - submit a new Student Transportation Request Form no less than two (2) days before the change is needed
Parent/Legal Guardian signature (use mouse to sign)
Name of Parent/Legal Guardian
Last Name
First Name
Middle Name
Date of Birth
Grade Entering
Relationship to Student
Before submitting form, please verify your answers. After pressing SUBMIT FORM, if there are errors, they will be noted in red.
Student's Home Address
City
State
Zip
Office Use Only
ITHACA CITY SCHOOL DISTRICT
400 Lake Street • P.O. Box 549 • Ithaca, New York • 14851-0549
