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STEO SpecialNeedsTransportationRequest
INSTRUCTIONS :
District
--Select--
Dufferin-Peel Catholic DSB
Other Schools
Upper Grand District School Board
Wellington Catholic District School Board
School
Grade
Student Last Name
Student First Name
Gender
--Select--
F
M
N
S
X
Birth Date
Student ID
Alternate ID
More than one student matches the criteria submitted. Please select the student to use
×
Select
Section I – Student Information
School Year
2015-2016
2016-2017
Start Date
End Date
Student timetable (Special transportation request)
Monday
Morning
Afternoon
Morning and Afternoon
Not Required
Tuesday
Morning
Afternoon
Morning and Afternoon
Not Required
Wednesday
Morning
Afternoon
Morning and Afternoon
Not Required
Thursday
Morning
Afternoon
Morning and Afternoon
Not Required
Friday
Morning
Afternoon
Morning and Afternoon
Not Required
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)
Section II – IPRC
Communication
Speech Impairment
Learning Disability
Autism
Deaf/Hard of Hearing
Behaviour
Multiple Exceptionality
Intellectual
Development Disability
Mild Intellectual Disability
Physical
Vision Impairment
Other Physical
Wheelchair
Review Date
Section III – Reason For Special Transportation Needs
1. Special Class Placement (50% or more time spent in Spec Ed.)
UCDSB SDC Programs
Developmental
Mutli Needs
CDSBEO/UCDSB out of Board
CHEO
ROH
McHugh
OCTC
Section 23
CDSBEO Programs
Turning Points
ABLE
ASD
MEP
LL-JR/INT
LD-LL-Junior
LD-JR/INT
School to Community
Program Location (Name and Address)
Name of Program/Site
Contact Name
Address
Phone Number
2. Other Special Needs of the Student
Comments
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?
Yes
Not Required
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
Email
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