Birmingham Public Schools Transportation Department 2205 Holland Birmingham, MI 48009 Bus Stop Change Request Student Name____________________________________________________________________ Full Address _____________________________________________________________________ School _______________________________________________________ Grade ____________ Home Phone _____________________________ Work Phone ___________________________ Current Bus Stop_________________________________________________________________ Requested Bus Stop _____________________________________________________________ Reason for Request ______________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ I understand consideration will be given to the above request, but change is not guaranteed. Due to the heavy volume of requests at the beginning of the school year, this request may take up to 3 weeks to resolve. Requests for students with no stop or stops that are safety concerns will receive highest priority. Parent/Guardian Name___________________________________________________________ (please print) Parent/Guardian Signature_______________________________________________________ Date:______________________________ Transportation Appeals Committee Decision: __________ Approved ___________ Denied Rationale: _________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Date:_______________________________