2024-2025 - Transportation Request to Columbus Academy

2024-2025 Transportation Request to Columbus Academy

New Albany-Plain Local Schools
Requesting Transportation for School Year *
Student Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Grade for the above school year*
Student Phone Number*
Please enter a valid phone number.
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
AM (Morning) Bus Stop Location:*

Dean Farm and New Albany Rd. E. (SW Corner)Kroger Shopping Center (Mutts & Co.)Market and Keswick (Library Side)Lambton Park and Pembrooke Pass (West Side Gazebo)Ebrington and Hanbys LoopNo Transportation Required
PM (Afternoon) Bus Stop Location:*

Dean Farm and New Albany Rd. E. (SW Corner)Kroger Shopping Center (Mutts & Co.)Market and Keswick (Library Side)Lambton Park and Pembrooke Pass (West Side Gazebo)Ebrington and Hanbys LoopNo Transportation Required
Residency Verification Required

Two (2) forms of proof of residency are required to verify residency:

1. One of the following:
- Signed Mortgage Deed or Apartment Lease. (Must list names of all occupants)
- Real Estate Tax Statement. One that has been mailed to the owner, not printed from the Auditor's site.
- Voter registration card
2. A Gas or Electric bill (unpaid and current)
Please upload your required proof of residency documents here.

Cancelof
Parent/Guardian 1 Name:*

First NameLast 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 NameLast 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 NameLast 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:*

Clear
Should be Empty:

2024-2025 Transportation Request to Columbus Academy