Date: ________
Memorandum for: Chief, Pacific Transportation Management Office (PACTMO)
Thru: District Transportation Supervisor
Subject: Waiver Request for School Bys Transportation
The following information is provided to support my request for a school bus 
transportation waiver:
1. Parent/Guardian Name and SSN: ____________________________
2. Student(s) Name: ____________________________
3. Home Street Address: ____________________________
4. Requested Pick-up/Drop-off point: ___________________
5. Home Phone: ___________ Work Phone: ____________
6. Command Sponsored:  Yes_____ No _____
7. The School The Student is Registered In: __________________
8. Justification: ____________________________
If this request for waiver is approved, I understand and agree to the following:
a. That transportation will only be provided if a bus is currently routed 
through the area in which alternate pick-up is requested.
b. My child will be riding on a space available basis.
c. Additional space required students who register for the bus my child is 
riding may displace my child if there is no other space available seats.
d. Transporting my child will be at no additional cost to the government.
e. PACTMO periodically surveys authorized ridership on bus routes, which 
could result in consolidating buses, reducing the number of space A 
seats available.
Requester's Printed Name: _________________________
Signature: ______________________
Official Use Only:
Bus Route_______ Bus Size: ______
Number of Available Space A Seats ________
Recommendation:
_____________________________________________
District Transportation Officer