Piner-Olivet Union School District

2018-2019 School Year

SCHOOL TRANSPORTATION Free & Reduced Bus PASS APPLICATION

Families with moderate income; receive AFDC or Food Stamps may qualify for free or reduced rate passes.

The passes are nontransferable and forgery or duplicate use of a pass will result in expulsion from the school bus. Passes need to be presented to the school bus driver upon boarding of the bus. RIDERS MUST SHOW PASS EACH TIME THEY BOARD THE BUS.

Children in Foster Care and children who meet the definition of Homeless are eligible for a free bus pass.

1st Student Name *
1st Student Name
Date of birth *
Date of birth
Foster Child / Homeless *
Check the applicable box
2nd Student Name
2nd Student Name
Date of birth
Date of birth
Foster Child / Homeless
Check the applicable box
3rd Student Name
3rd Student Name
Date of birth
Date of birth
Foster Child / Homeless
Check the applicable box
4th Student Name
4th Student Name
Date of birth
Date of birth
Foster Child / Homeless
Check the applicable box
Home Mailing Address *
Home Mailing Address
Phone *
Phone
Do ANY household members (including yourself) currently participate in one of the following assistance programs? *
Parent/ Guardian *
Parent/ Guardian
$
OTHER HOUSEHOLD MEMBER (all household members must be listed)
OTHER HOUSEHOLD MEMBER (all household members must be listed)
$
OTHER HOUSEHOLD MEMBER (all household members must be listed)
OTHER HOUSEHOLD MEMBER (all household members must be listed)
$
OTHER HOUSEHOLD MEMBER (all household members must be listed)
OTHER HOUSEHOLD MEMBER (all household members must be listed)
$