Hartford Public Schools Transportation Department

Summer School Sped 2008

SUMMER SCHOOL TRANSPORTATION REQUEST FORM SPECIAL ED

960 Main Street

Hartford, CT 06103

860-695-8547

*Student ID *Vendor (Select One)
Dattco (Cluster Stop)
Logisticare (Door to Door)
*Date of Request - mm/dd/yy *Summer Transportation Request (Select One) *Bus Monitor Suggested:
Yes
No
*Type Equipment Requested:
Wheelchair Vehicle
Car Seat
Vest/Harness
None Required
*What Kind of Summer Request? Type of Disability: *Student Last Name *Student First Name *DOB - mm\dd\yyyy *Grade (Select One) *Current Street Address *Pick Up Address *Drop Off Address Old Street Address ( If applicable) *Current City, State, Zip Old City, State, Zip (Only Suburban Magnet) Sending Town (Only Suburban Magnet) Enter Sending School *Enter Receiving School *Parent/Guardian Name *Home Phone Number Work Phone Number Cell Phone Number *Name of Person Sending Request *Enter your Email (Required for Confirmation Return) *School Phone Number Comments or Special Instructions:

Requests will be reviewed and acted upon within 3 school days from the date received. If you have any questions please call the Transportation Hot Line at 695-8547.

Thank You,

Transporation Department.

Hartford Public Schools Transportation Department

School Year 2008-2009

Summer School Sped 2008