Non-Public School Transportation Request

Request Type*

New Student
Returning Student
Information Change
Payment In Lieu (PIL)

School*

School Address*

Street Address City

Effective Date*

Grade*

select the grade your student will be in at the effective date

Time Transportation is Needed*

AM
PM
N/A (I am a current recipient of payment in lieu for transportation)

Note: You are not eligible for payment in lieu if service is available.

Student Information

Name*

First MI Last

Birth Date*

Sex

Male
Female

Home Address*

Subdivision Street Address City State ZIP Code

Parent/Guardian Information

Primary Parent/Guardian Name*

First Last

Primary Parent/Guardian Email*

Enter Email Confirm Email

Phone*

Work Phone

Cell Phone

Primary Parent/Guardian Home Address*

Same as student's address

Subdivision Street Address City State ZIP Code

Secondary Parent/Guardian Name

First Last

Secondary Parent/Guardian Email

Enter Email Confirm Email

Phone

Work Phone

Cell Phone

Secondary Parent/Guardian Home Address

Same as student's address

Subdivision Street Address City State ZIP Code

Confirmation*

By checking this box and submitting this form, I affirm that the information on this form is true and correct. I also affirm the student address is residing within the Hilliard City School District boundaries and that I/we meet residency requirements.

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Non-Public School Transportation Request

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Parent/Guardian Information

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