ONLINE BUS TRIP REQUEST

Online Bus Trip Request Form

Clark County Transportation Department (09.36 AP.212- Bus Use Form)
Request Date and Time:

MonthDayYearHourMinutesAM/PM Option
Funding Source: *

Board FundsSBDM FundsSchool Activity FundsOther
Administrator's Approval:*

Yes
Admin Making Trip Request:*

First NameLast Name
Admin's E-mail Address:*
Your E-mail Address
School/Department:*
Organization:*
Grade, Team, Club
Trip Destination:*
Teacher/Coach/Sponsor:*

First NameLast Name
Teacher/Coach/Sponsor's E-mail Address:*
Teacher/Coach/Sponsor Contact Number:

Area CodePhone Number
Departure Date: *

MonthDayYear
Departure Time:*

:HourMinutesAM/PM Option
Departure Location: *
Return Date: *

MonthDayYear
Return Time:*

:HourMinutesAM/PM Option
Return Location:*
Trip Special Details:
Special Needs Bus Required?:*

YesNo
Number of Students:*
Driver to Stay: *

YesNo
Once the "Submit" button is selected your Trip Request will automatically be submitted to the Transportation Department. You will be charged a minimum of 15 miles/trip at $3.00/mile plus driver/hour.

Assignment Record

Clark County Transportation Department
Trip Number:
Enter Trip Number (Last 4)
School/Department:
Trip Destination:
Driver to Stay:

YesNo
Departure Date:

MonthDayYear
Departure Time:

:HourMinutesAM/PM Option
Departure Location:
Return Date:

MonthDayYear
Return Time:

:HourMinutesAM/PM Option
Return Location:
Number of Students:
Sponsor's Name:
Sponsor Contact Number:

Area CodePhone Number
Organization:
Assigned To:
Processed:

Yes
Bus Number:
Driver's Contact Number

Area CodePhone Number
Trip Special Details:
Start Time:
Mileage Reading:
Time Arrived at Departure Location:
Mileage Reading:
Time Arriving Back to Departure Location:
Mileage Reading:
End Time:
Mileage Reading:
Total Time on Trip:
Hours
Total Miles Driven:
Driver's Signature: ________________________ Sponsor's Signature: __________________________

Payment Record

Clark County Transportation Department
Transportation Invoice
Clark County Board of Education
1600 W Lexington Ave
Winchester KY 40391
859-744-4545
Trip Number:
Departure Date:
Trip Destination:
Billed To:
Funding Source:
Teacher/Coach/Sponsor's Name:
Organization:
Assigned To:
Bus Number:
Total Miles Driven:
x Mileage Rate:
= Total Cost Miles Driven:
Time Out on Trip:
Hours
x Cost per Hour:
= Total Cost for Driver:
Total Trip Cost:
Finance Only:

Paid in FullJournal EntryOther
Please return a copy of this Invoice with your check to Central Office.
Thank You
Should be Empty:

Assignment Record