This request shall be filed by the parent or guardian of eligible nonpublic school students with the secretary of the local school district for the first and second semesters upon request. This request must be filed prior to the end of the fiscal year (N.J.A.C. 6A:27-2.1(c)).
I, Parent/Guardian First Name* Parent/Guardian Last Name* do hereby certify that Student First Name* Student Last Name* who resides at Street Address of Student* City* State* Zip* has been transported to Nonprofit Private School* situated in City* State* not more than 20 miles from the residence of the student for the period of time from Date* to Date*. In consideration thereof, I hereby request payment of transportation aid pursuant to N.J.S.A 18A:39-1.
I do solemnly declare and certify under the penalties of the law that this request for payment is correct in all its particulars and that I am not claiming reimbursement or receiving transportation from any other school district for the same period of time.
WHEN PROPERLY EXECUTED, THIS FORM MAY BE ACCEPTED AS AN OFFICIAL VOUCHER. THE LOCAL BOARD OF EDUCATION MAY PAY TRANSPORTATION AID BASED ON THIS CLAIM PURSUANT TO N.J.S.A. 18A:39-1 and 18A:19-3