STWDSTS TransportationPlan

District

School

Grade

Student Last Name

Student First Name

Gender

Birth Date

Student ID

Alternate ID

House/Apt. number

Street name

Suffix

City/Town

Postal/Zip Code

Phone

Consultant/Principal

Reason for ISTP

#	Particulars	Yes	No	Comments
1	Does the student require transportation?
2	Can the student utilize regular home to school transportation if provided?
3	Does the parent/guardian need to bring the student to the bus stop and meet the student at the stop in the pm?
4	Does the student require additional supervision while in transit (aide, nurse, etc)
5	Does the student require ancillary aids during transportation? (oxygen, seeing eye dog, etc)
6	Does the student require a wheelchair accessible vehicle or other specialized mode of transportation?
7	The Board transporation policy allows for a student to ride for up to one hour. Does the student's condition warrant any special consideration?
8	Will the student be able to remain seated for that period of time?
9	Will the student pose a risk of injury to either him/herself or to others?
10	Will the student require a harness to remain in his/her seat? If so, requires parental consent.
11	Does the student have a medical condition that may present itself during tranpsortation? (diabetes - insulin shock; epilepsy - seizures, allergies - anaphylaxis, etc)
12	Are there any special instructions regarding the response to those medical condtions? (epipen, etc)
13	Are there any special strategies that can be utilized to assist the student while in transit? (explain)
14	Does the student have a life threatening medical plan? Have you provided a copy to STWDSTS?
15	Consultation with Parent/Guardian
16	Consultation with Student
17	Consultation with STWDSTS

Submitted by I acknowledge that transportation procedures will apply.

Last Name

First Name