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Holland Central School District

Permanent Bus Pass Information

2023-2024

ONLY fill out this form if your child needs to go to an alternate point (a location other than home) on a consistent regular basis.
ONE ALTERNATE ADDRESS is permitted; this eliminates confusion and preserves the welfare of each student.
We MUST receive this request on or before 8/18/2023 for changes to be in effect for the first week of school.
REMEMBER - Bus pass information does NOT carry over from the last school year

Effective Date (Please allow 3-5 days for processing) *

Student First Name *

Student Last Name *

Student ID #

Grade *

Teacher Name

Parent Name *

Parent Email Address *

Parent Signature

Type your name and sign below

Home Address *

City, State, Zip *

Phone *

Route # (if known)

Address of Alternate Pickup or Drop-Off site

Name *

Street Address *

City, State, Zip *

Phone *

Route # (if known)

Please select the PM that your child will need to be dropped off at the alternate site. *

Please select the PM that you will be picking your child up at the end of the day, on a regular basis. *

Provide any additional notes as needed: *

A number of approval stages need to be completed before this submission can be accepted.

Appropriate approvers from the Transportation Change Approval group will be automatically allocated for this approval stage.