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Series 707.10.2P - Nonpublic Student Transportation Reimbursement Request

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.

Return to:

Independent School District 196

Director of Finance and Operations

3455  153rd Street West

Rosemount, MN  55068

NOTE:

To qualify for reimbursement for

the current school year, this

form must be returned no later

than June 30.

 

__________________________________

  parent/guardian name (please print)

 

___________________________________

  address

 

___________________________________

  city, state, zip code

 

___________________________________

  telephone number

 

___________________________________

  signature of parent or guardian

 

___________________________________

  date

 

Procedures/707.10.2P/9-9-13