Forms
(current)
Log In
Loading
Forms US_FL_SLPS ExtendedSchoolYearRequest
School Year
2027
2028
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
More than one student matches the criteria submitted. Please select the student to use
×
Select
Select Weighted or Unweighted
Weighted (Requires special transportation)
Unweighted (Regular bus)
Section A: Student Information
Parent/Guardian
Last Name
First Name
Home Phone
Work Phone
Cell Phone
Address
Number
Street
City
Zip Code
Apartment
Mailing Address (if different from above)
Transportation required for
Home Address
Pickup Address
Drop Off Address
Section B: Stop Location Information
Date
A.M Pick Up (from)
Home
Pickup
Drop Off
P.M Drop Off (to)
Home
Pickup
Drop Off
Section C: Alternate Address Information
Pickup
Last Name
First Name
Home Phone
Work Phone
Cell Phone
Address
Number
Street
City
Zip Code
Apartment
Drop Off
Last Name
First Name
Home Phone
Work Phone
Cell Phone
Address
Number
Street
City
Zip Code
Apartment
Communication Issues
Student uses sign language
Student uses a communication device
(please describe)
Other
(please describe)
Exceptionalities
Autism Spectrum Disorder
Occupational Therapy
Deaf or Hard-of-Hearing
Orthopedic Impairment
Developmental Delay (Age: 0-5)
Other Health Impairment
Dual-Sensory Impairment
Physical Therapy
Emotional or Behavioral Disability
Specific Learning Disability
Hospitalized or Homebound
Speech Impairment
Intellectual Disability
Traumatic Brain Injury
Language Impairment
Visual Impairment
Equipment
Air Conditioning
(attach physician request)
Wheelchair
N/A
Manual
Motorized
Lap Tray (will remove during transit)
Posititioning or Seating Device
Car Seat
Height
Child Safety Restraint System (CSRS)
Safety Vest
Weight
Integrated Seat
Waist
Lap Belt
Crutches
Walker
Cane
Can the student climb the bus steps?
Yes
No
Medical Issues
Allergies
(please describe)
EpiPen
Asthma
Inhaler
Brittle Bones
Diabetic
Needs Snack on bus
Oxygen
Gas
Liquid
Seizures
Medication
(please identify)
Shunt
Left
Right
Tracheotomy Equipment
Ventilator
Other Health Concerns
(please describe)
Describing the other health concern is required if this option is checked.
Personnel
Attendant/paraprofessional to assist the student with
An Attendant's name is required
Behavioral issues (include Behavioral Intervention Plan)
Physical Needs
Safety Needs
Nurse
1:1 Attendant
Other (please describe)
Other Needs
Isolated Reimbursement
Other (please describe)
Plan B (short-term plan when equipment is broken, nurse is sick, etc.)
Parent will transport the student
Other (please describe)
Submitted by
I acknowledge that transportation procedures will apply.
Last Name
First Name
Email
<%= Resource: Campaigns_Prompt%>
×
<%= Resource: Yes %>
<%= Resource: No %>