ODBES TRIP REQUEST

Trip Request

Ohio Deaf and Blind Education Services
Requester Information
Requested by
Email
example@example.com
Department
Campus Location
Today’s date

MonthDayYear
Date
Requester’s phone number
Format: (000) 000-0000.
OSD Supervisor
OSSB Supervisor
Destination Information
Destination
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this destination outside of Ohio?
Departure Date

MonthDayYear
Date
Departure Time
*RETURN DATE MUST BE THE SAME DATE AS THE DEPARTURE DATE OR LATER*
Return Date

MonthDayYear
Date
Return Pick-up Time
Estimated Arrival Time to Campus
To estimate an arrival time, add the pickup time and the travel duration time together.
Do You Have Additional Destinations?
How Many Additional Destinations?
Destination Information #2
Destination
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Destination Information #3
Destination
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Destination Information #4
Destination
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Purpose
Total Mileage
Logistical Needs
Do you need a driver?
Vehicles: (Check all that are needed)
Cargo Specifications
(Bus limits: 1 suitcase + 1 carry-on per person) List how much luggage, sporting equipment, etc.
Loading Areas:
OSSB areas
OSD Areas
Roster of Participants
Estimated number of student passengers

Student Riders: (provide one name per cell below or attach a separate word document)

Student Riders (upload document)

Cancelof
For bus driver communication, provide name and phone number of a staff person attending the trip.
Estimated number of Adult passengers

Adult Riders: (provide one name per cell below or attach a separate word document)

Adult Riders (upload document)

Cancelof
FOOD Service:
Will you be submitting a food request for this trip?
MEDICAL NEEDS:

Contact Student Health Services for Emergency Medical Forms. Forms needed for ALL Trips.
Additional Notes
**All out of state trips must be approved by the Superintendent or designee.**
Should be Empty:

Trip Request