Parent Mileage Reimbursement Request Form

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The State of Nebraska allows mileage reimbursement to school districts for students. Qualification for reimbursement is based on free lunch status and is applicable on a per family basis. The formula for providing reimbursement to parents is based on actual miles (one way) to the nearest bus stop minus three miles. Miles are multiplied by the days of attendance.

Beginning in the 2023-24 school year, mileage reimbursement must be requested by the families. You may request reimbursement using this form located on the Boone Central website, under the Parent/Student tab-General Links

Email *

Record my email address with my response

Date of Request *

YYYY

Parent Name *

Child(rens) Name(s)

Home Address *

Miles from nearest bus stop *

Reimbursment request for *

Semester 1

Semester 2

Reimbursement request for fiscal year *

I understand and agree to the terms and conditions of the State of Nebraska mileage reimbursement rate and am affirming our family falls within the guidelines of the reimbursement.

I also understand that I must submit a mileage reimbursement request form for each semester that I wish to receive reimbursement for.

Yes

Electronic Signature *

Date

YYYY

Submit

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