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  • Brett Saucier

EEBB-R1

Updated: Feb 6

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

Superintendent

Steve Connolly

Assistant

Superintendent

Susan S. Austin

Phone: 207-676-2234

Fax: 207-676-3229

100 Noble Way, North Berwick, ME 03906

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