OSTA EmptySeatApplication

District

School

Grade

Student Last Name

Student First Name

Student ID

Alternate ID

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

Select

Home Address

Apt

Number

Street

City

Postal Code

Transportation Request (Please select the appropriate box)Select a Transporation Request

Before School (AM) ONLY

After School (PM) ONLY

Both Before School (AM) AND After (PM) School

If you are expecting your child to go to an address other than home (e.g., caregiver/daycare), please specify that location below. Leave blank if you want transportation provided to HOME (address provided above).

Alternate Address

Apt

Number

Street

City

Postal Code

Special Circumstances to Consider

Please indicate the specific reason(s) why you are requesting a seat on a school bus. Additional comments can be made in the section below.

Sibling on Bus	Medical (student)	Medical (family member)
Unsafe Route	Distance	Cross Boundary
New Canadian/Exchange Student	Single Parent/Financial	Joint Custody
Caregiver	No Specific Reason

Additional Comments (max 300 characters)

Submitted by

By submitting this form, I understand that my child is not eligible for transportation under the regular distance criteria established and may be granted permission to ride a school bus under OSTA’s T1 Access to Empty Seat Policy. I have read the administrative procedures and agree to these terms and conditions. Transportation provided under these conditions is a privilege, which may be revoked at any time for i) misbehaviour on the school bus, ii) the service required for an eligible student, or iii) if changes are required to route services to obtain operational efficiencies.

Last Name

First Name

CONFIDENTIALITY STATEMENT

In accordance with the Personal Information Protection and Electronic Documents Act, Article 29, Paragraph (2), personal information requested in this form will assist in providing transportation services. The information is gathered in accordance with the Education Act S.R.O. 1980, c. 129, s.166(1).

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