Form for Testing

INSTRUCTIONS :

School

Grade

Student Last Name

Student First Name

Gender

Birth Date

Student ID

Alternate ID

Section I – Student Information

School Year

Start Date

End Date

Student timetable (Special transportation request)

Monday

Tuesday

Wednesday

Thursday

Friday

Comments

Home Address

Street number

Street name

Suffix

City/Town

Postal/Zip code

Telephone (home)

Telephone (mother / guardian)

Telephone (father / guardian)

Morning Pickup Address

Same as home address (see above) If address is different, please complete the section below:

House/Apt. number

Street name

Suffix

City/Town

Postal/Zip code

Contact name

Contact phone

Contact phone (alternate)

Afternoon Drop-off Address

Same as home address (see above) If address is different, please complete the section below:

House/Apt. number

Street name

Suffix

City/Town

Postal/Zip code

Contact name

Contact phone

Contact phone (alternate)

Review Date

Section IV – Life Threatening Emergency Forms

Are 'Life Threatening Emergency Medical' form(s) required for this child and if so please ensure that a copy is forwarded to STEO, the Bus Contractor and the Bus Driver?

Section V – Transportation Requirements

Buckle Guard

Harness

Booster Seat

Other

If 8 years of age and under

Student Weight (kg)

Student Height (cm)

Special instructions/comments

Comments

State all conditions/limitations of the student

List any additional equipment that is required to transport the student

Submitted by

Last Name

First Name

Form for Testing

INSTRUCTIONS :

Student timetable (Special transportation request)

Home Address

Morning Pickup Address

Afternoon Drop-off Address

Communication

Intellectual

Physical

1. Special Class Placement (50% or more time spent in Spec Ed.)

UCDSB SDC Programs

CDSBEO/UCDSB out of Board

CDSBEO Programs

Program Location (Name and Address)

2. Other Special Needs of the Student

If 8 years of age and under

Special instructions/comments

State all conditions/limitations of the student

List any additional equipment that is required to transport the student

Form for Testing

INSTRUCTIONS :

More than one student matches the criteria submitted. Please select the student to use

Student timetable (Special transportation request)

Home Address

Morning Pickup Address

Afternoon Drop-off Address

Communication

Intellectual

Physical

1. Special Class Placement (50% or more time spent in Spec Ed.)

UCDSB SDC Programs

CDSBEO/UCDSB out of Board

CDSBEO Programs

Program Location (Name and Address)

2. Other Special Needs of the Student

If 8 years of age and under

Special instructions/comments

State all conditions/limitations of the student

List any additional equipment that is required to transport the student

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