Request for Special Education Transportation

Request for Special Education Transportation

Please complete this form for every annual IEP or amendment to an IEP where transportation is being listed as a service.
The decision to provide specialized transportation to a student as a related service within their Individualized Education Program must be made through the IEP process with the entire IEP team. Make sure you have used this protocol with the IEP team, prior to making a request for specialized transportation.

*Exceptions include (meaning you don't need to go through this full process before making a request for specialized transportation):
- If a student attends an alternative program
- If a student attends an alternative classroom that is outside of their catchment
- If the team has already gone through the above process, and circumstances that led to the need for specialized transportation have not changed.
*Transportation MUST be documented as a service in the student's IEP*
Name of Person Filling Out Transportation Request Form*

First NameLast Name
Student's Name*

First NameLast Name
Student's Date of Birth*

MonthDayYear
Date
Student's Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Program of Main Attendance*
Student's Grade*
Date of IEP Mtg where Transportation was Discussed*

MonthDayYear
Date
Please upload meeting minutes here, documenting the discussion related to transportation at the above IEP Mtg date*

Cancelof
Please summarize reason(s) why this student requires specialized transportation. This should come directly from the transportation discussion at the IEP mtg or from the criteria listed in Step 1 of the Transportation for Students with Disabilities, IEP Decision Making Process document*
The purpose of this transportation service is:*

Home to Alt Placement to HomeHome to Gen Ed School to HomeTransitionVocationalCommunity BasedOther
Please indicated which, if any, of the following accommodations are required for this student:*

Bus with wheelchair liftBus with specialized seat belt restraints/harnesses/car seatAdult support during transportPick up or drop off at an alternate location from regular bus stopShortened school dayOther
Transportation Logistics

Please complete the details needed to arrange for specialized transportation below.
Pick-up location (AM): Street Address*  City*
Drop off location (AM): Street Address*  City*
Pick-up location (PM):  Street Address* City*
Drop off location (PM): Street Address* City*
Ideal Start Date for this Transportation*

MonthDayYear
Date
End Date (if temporary)

MonthDayYear
Date

Please indicate the times for drop-off (at school program), and pick-up (at school program) for each day of the week. (If transportation is not needed on a particular day, leave that day blank)*

	Monday	Tuesday	Wednesday	Thursday	Friday
Drop Off
Pick-up

This section is for any other notes/needs related to transportation for this student, that are not outlined above:
Should be Empty:

Request for Special Education Transportation

*Transportation MUST be documented as a service in the student's IEP*

Transportation Logistics

Transportation MUST be documented as a service in the student's IEP