To: Susan Tandberg

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					LAUSD | Division of Special Education
District Office of Transition Services

Transition Instruction Activity Bus Order
Cover Sheet




Requesting Person:                                                  Date of Request:

Funding: DOTS Job # 0240
Transition Instruction Activity – Bus Request

Day of the week and date of trip:              # of Students:
School of Departure:
Location Code:                    Program/Eligibility: Program/Eligibility
Address:
Phone Number:

*Note any other schools whose students will be picked up for this trip.
(An Appendix A is required from each school administrator to cover their students.)


Destination:
Location# (if applicable):                      Address:

*Note any additional destination sites*


Targeted Objective of Trip:


Instruction Pre and Post Trip:


Signature of School Administrator: ________________________Date:

Signature of DOTS Specialist: __________________________Date:




   333 S. Beaudry Avenue, 17th Floor, Los Angeles, CA 90017 | (213) 241-8050 Fax: 241-4185 | http://sped.lausd.net

				
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posted:9/13/2012
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