Payment in Lieu of Transportation

Bus requests must be submitted every year.

"*" indicates required fields

School of Attendance Information

School*

Effective Date*

Grade*

Grade at the time of effective date.

Student Information

Student Name*

First MI Last

Birth Date*

Sex*

Male

Female

Home Address*

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

Parent/Guardian Home Address

Same as student's address

Street Address City State ZIP Code

Second Parent/Guardian Information

Second Parent/Guardian Name

First Last

Second Parent/Guardian Email

Enter Email Confirm Email

Phone

Work Phone

Cell Phone

Second Parent/Guardian Home Address

Same as student's address

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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