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EC Transportation Request
New Student
Existing Student
School Year
2023-2024
2024-2025
School
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BAILEY ELEMENTARY SCHOOL
BASKERVILLE ELEMENTARY SCHOOL
BENVENUE ELEMENTARY SCHOOL
CITI HIGH SCHOOL
COOPERS ELEMENTARY SCHOOL
DS JOHNSON ELEMENTARY SCHOOL
EDWARDS MIDDLE SCHOOL
ENGLEWOOD ELEMENTARY SCHOOL
FAIRVIEW EARLY CHILDHOOD CENTER
HUBBARD ELEMENTARY SCHOOL
MIDDLESEX ELEMENTARY SCHOOL
NASH CENTRAL HIGH SCHOOL
NASH CENTRAL MIDDLE SCHOOL
NASHVILLE ELEMENTARY SCHOOL
NORTHERN NASH HIGH SCHOOL
NRMPS EARLY COLLEGE HIGH SCHOOL
PARKER MIDDLE SCHOOL
RED OAK ELEMENTARY SCHOOL
RED OAK MIDDLE SCHOOL
ROCKY MOUNT HIGH SCHOOL
ROCKY MOUNT MIDDLE SCHOOL
SOUTHERN NASH HIGH SCHOOL
SOUTHERN NASH MIDDLE SCHOOL
SPRING HOPE ELEMENTARY SCHOOL
TAR RIVER ACADEMY
WILLIFORD ELEMENTARY SCHOOL
WINSTEAD AVENUE ELEMENTARY SCHOOL
Grade
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P0
P1
P2
P3
PK
KI
1
2
3
4
5
6
7
8
9
10
11
12
13
Student Last Name
Student First Name
Gender
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F
M
N
S
X
Birth Date
More than one student matches the criteria submitted. Please select the student to use
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Powerschool Student ID
EC Category
Autism
Deaf-Blindness
Developmental Delay
Emotional Disturbance
Hearing Impairment
Intellectual Disability
LD
Multiple Disabilities
Orthopedic Impairment
Other Health Impairment
Speech or Language Impairment
Traumatic Brain Injury
Visual Impairment Including Blindness
504 Plan
Yes
No
IEP
Yes
No
Section I – Student Information
Student timetable (Special transportation request)
Regular
5 days/week
Monday
Morning
Afternoon
Morning and Afternoon
Tuesday
Morning
Afternoon
Morning and Afternoon
Wednesday
Morning
Afternoon
Morning and Afternoon
Thursday
Morning
Afternoon
Morning and Afternoon
Friday
Morning
Afternoon
Morning and Afternoon
Arrival Time (Requested)
Departure Time (Requested)
School Day (Full or Abbreviated)
Home Address
Street number
Street name
Suffix
City/Town
Postal/Zip code
Telephone (home)
Telephone (mother / guardian)
Telephone (father / guardian)
Emergency Contact Name
Emergency Contact Phone
Section II – Services Required (check all that apply)
Support Animal
Car Seat
Meet at Door
Air Conditioning
Booster Seat
Electric Port
School Bus Monitor
Harness
*
Chest Measurement
Weight
Effective Date
Retire Date
* The use of a Restraint System (harness) is justifiable only in medical cases requiring additional physical support for the posture of a student. The harness cannot be used for behaviour management.
Section III – Reason(s) for Special Transportation Request (check all that apply)
Wheelchair
Walker
Crutches
Oxygen Tank
Blindness
Deaf
Stroller
Prosthetic Device
Medical
Diagnostic
Other
Section IV – Transportation
Aboard the vehicle
How to interact/communicate with the student
Possible behavioural issues (e.g. escape, aggression)
Prevent ative strategies (e.g. music, object to keep them busy)
School responsibilities
At Pickup
Accompany the student to the vehicle.
At Drop-off
Meet the student at their vehicle at the specified time.
Parent / guardian responsibilities
At Pickup
Accompany the student to the vehicle.
At Drop-off
Meet the student at their vehicle at the specified time.
Comments
Section V – Communication (check all that apply)
Can travel with other students
Behavior Plan
Comments
Understands English
Comments
Understands Spanish
Comments
Needs additional communication tool(s)
Specify
Medication
List carried by student
Location (e.g. backpack)
To be communicated to emergency services
Allergies
Section VI – Comments
Submitted by
I acknowledge that transportation procedures will apply.
Job Title
Last Name
First Name
Email
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