Transportation Alternative Site Request Form
Public school 2025-2026
Student Attendance Information
School Selection
*
Please Select
Chestnut Ridge Middle School
Early Childhood Center - ECC
Eldorado Elementary School
Elmwood Elementary School
Fleetwood Elementary School
Hempstead Elementary School
Kakiat Steam Academy
Pomona Middle School
Summit Park Elementary School
Student First Name
*
Student Last Name
*
Student ID
Call Reg
Entering Grade
*
Please Select
K
01
02
03
04
05
06
07
08
09
10
11
12
Guardian Cell or Work Phone #
*
Please enter a valid phone number.
Home Phone number
*
Please enter a valid phone number.
Email Notifications
example@example.com
Date of Birth
*
/
Month
/
Day
Year
Student Pick-up Information
First Name
Last Name
*
Phone Number
*
###-### - ####
Cell Phone Number
###-### - ####
Pick up Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Drop Off Information
Requesting Starting Date
*
-
Month
-
Day
Year
Date
First Name
Last Name
Phone Number
*
###-### - ####
Cell Phone Number
*
###-### - ####
Guardian 2 Address
Street Address Line 2
City
State
Zip
All requests must be for
5 days
per week, to and from the same location.
The requested childcare provider must be within the student's home school attendance
zone
.
Childcare providers
must
accompany Kindergarten students to and from bus stops.
Guardian 1 First Name
*
Guardian 1 Last Name
*
Date
/
Month
/
Day
Year
Date
Preview PDF
Submit
Signature of Guardian 1
*
Should be Empty: