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
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