MID-PLACER PUBLIC SCHOOLS TRANSPORTATION AGENCY BUS PASS APPLICATION

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BUS PASS APPLICATION FOR ALL MEMBER DISTRICTS

Student Name *

Grade *

School *

Parent\Guardian Name *

Home Phone *

Cell Phone *

Work\Emergency Phone *

Address *

Mailing Address (if different from above)

Email Address (this is how we send notices)

Check all that apply to your student *

Both AM\PM

AM Only

PM Only

Band Bus

Boys & Girls Club

Required

Select Fee Schedule for One Child

Yearly Fee $270.00

Semester Fee $150.00

Reduced Yearly Fee $80.00

Reduced Semester Fee $50.00

Clear selection

Select Fee Schedule for Two Children

Yearly Fee $475.00

Semester Fee $255.00

Reduced Yearly Fee $135.00

Reduced Semester Fee $80.00

Clear selection

Select Fee Schedule for Three or More

Yearly Fee $680.00

Semester Fee $350.00

Reduced Yearly Fee $190.00

Reduced Semester Fee $110.00

Clear selection

Clear form

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