EEBB-R1

EEBB-R1

EMPLOYEE REQUEST TO TRANSPORT STUDENTS BY PERSONAL VEHICLE- Form 

The following information must be provided to the Superintendent of Schools prior to approval being granted for employees to transport students by personal vehicle: 

1. Employee making request: ______________________________________________

2. Proposed driver, if other than employee:____________________________________

3. Date(s) of requested travel:______________________________________________

4. Destination:__________________________________________________________

5. Reason for Trip:_______________________________________________________

6. Proposed Itinerary, with approximate times of travel:  _______________________

____________________________________________________________________

____________________________________________________________________

7. Vehicle to be driven: Make/Model: Year: ________________________________

8. Insurance Provider: _________________________________________________

9. Policy Number:____________________________________________________ 

You must provide with this request:

                _____ One copy of the proposed driver’s current license.

  _____ One copy of the Declaration page or Certificate of Insurance from the driver's insurance provider, showing appropriate levels of current coverage.

    _____ One copy of vehicle registration

                _____ A list of all students to be transported.

By signing this document, you are agreeing that you have read and understood the Employee Vehicle Use Procedures (EEBB-R) and will comply with all items noted therein. 

_______________________________           ________________________

Employee’s Signature                                                           Date