Rhode Island Department of Education
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Home Address Information was changed. Please confirm Transportation Information Section (dropoff/pickup information) is accurate.
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Statewide Transportation Request for Out-of-District Students
This form to be completed by the Special Education Director or Designee
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Effective Date Status:
last updated on 5/4/2022 12:45:35 PM, by ccha04. Created on 9/14/2020 2:57:10 PM, by ccha04. *  required fields 
Student Information
Last Name* First Name* MI
Home Phone* Date of Birth* Gender
  (format: xxx-xxx-xxxx)        
Home Address          
House #* Street* Apt/Box
City* State* Zip Code*
            
Parent/Guardian Name* SMS Text Contact #
Transportation Information
Pickup Address Type of Address*
House #* Street* Apt/Box
City* State* Zip Code*
            
Dropoff Address Type of Address
House #* Street* Apt/Box
City* State* Zip Code*
           
Note: Alternate addresses must follow all eligibility rules. Pickup/Dropoff addresses must be consistent throughout the week.

Emergency Information
Name 1*
Relationship* Phone*
    
Name 2
Relationship Phone
School and Need Information  
Grade* School of Attendance*
Resident District* Program Start Time*  (eg, 7:00 AM)
    Program End Time*  (eg, 3:00 PM)
Attendance Days *
OR
Enrollment Status*
Information Fields*
 
Student Specific Information* Please provide detailed student specific information and/or any pertinant information needed for working with student (ie, is the student deaf, visually impaired, etc.)
0/500
Does the student have a transportation plan document?

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*Process time for this change may take up to 48 hours, calculated in work days from the time the request is received