Adopted: September 1981
Revised: September 2013
I/We request reimbursement for transporting the following child(ren) as per District 196 Regulation 707.10AR, Nonpublic and Charter School Student Transportation for the current school year. I understand that this request must be submitted to District 196 prior to June 30 for reimbursement for the current school year.
student name grade school school phone #
I understand the payment is not to exceed the amount of the district’s nonpublic transportation revenue per student minus five percent administration cost.
Independent School District 196
Director of Finance and Operations
3455 153rd Street West
Rosemount, MN 55068
To qualify for reimbursement for
the current school year, this
form must be returned no later
than June 30.