Transportation Request to Eastland-Fairfield Career Center
New Albany-Plain Local Schools
Requesting Transportation for School Year
*
Please Select
2024-2025
Student Name
*
First Name
Middle Name
Last Name
Student Phone Number
*
Please enter a valid phone number.
Grade for the above school year
*
Please Select
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Date of Birth
*
-
Month
-
Day
Year
Date
PowerSchool ID
*
Enter only numbers
Student Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I require morning transportation:
*
From my assigned residential bus stop to the Eastland Campus
From NAPLS Campus to Eastland (if you drive to NAPLS due to after school activities)
From my assigned residential bus stop to Fairfield Campus
From NAPLS Campus to Fairfield (if you drive to NAPLS due to after school activities)
I require afternoon transportation:
*
From Eastland to my assigned residential bus stop
From Eastland to NAPLS Campus (if you drive home from NAPLS due to after school activities)
From Fairfield to my assigned residential bus stop
From Fairfield to NAPLS Campus (if you drive home from NAPLS due to after school activities)
Parent/Guardian 1 Name:
*
First Name
Last Name
Main Phone 1:
*
Please enter a valid phone number.
Work Phone 1:
*
Please enter a valid phone number.
Other Phone 1:
Please enter a valid phone number.
Email 1:
*
example@example.com
Parent/Guardian 2 Name:
First Name
Last Name
Main Phone 2:
Please enter a valid phone number.
Work Phone 2:
Please enter a valid phone number.
Other Phone 2:
Please enter a valid phone number.
Email 2:
example@example.com
IF EMERGENCY CONTACT IS OTHER THAN A PARENT/GUARDIAN PLEASE COMPLETE THE FOLLOWING:
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Relationship to Student:
(ex: aunt, uncle, grandmother, neighbor)
My signature certifies that the above information is correct.
I agree to notify the Transportation Department Immediately if an of the above information changes.
Parent/Guardian Signature:
*
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Submit
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