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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‚Äč.  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

Monday

Tuesday

Wednesday

Thursday

Friday

Morning Day Care

Afternoon Day Care

Provider Name

Provider Address

 

Provider Phone Number

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

Current Signature

Parent/Legal Guardian signature (use mouse to sign)

Name of Parent/Legal Guardian

STUDENT INFORMATION

Last Name

First Name

Middle Name

Date of Birth

Grade Entering

TRANSPORTATION REQUEST
ACKNOWLEDGEMENT
*

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

DAY CARE INFORMATION

                                                                               Office Use Only