Request for Payment of Transportation Aid - Charter and Renaissance School Students

NEW JERSEY STATE DEPARTMENT OF EDUCATION

Division of Finance Office of Student Transportation
REQUEST FOR PAYMENT OF TRANSPORTATION AID - CHARTER AND RENAISSANCE SCHOOL STUDENTS
This request shall be filed by the parent or guardian of eligible charter and renaissance 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:27-3.4(b)).
I, First Name* Last Name* do hereby certify that First Name* Last Name* who resides at Street Address* City*, State* Zip* has been transported to Charter/Renaissance School Name* located in City*, State* for the period of time from Start Date* to End 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 it's particulars, and that I am not claiming reimbursement or receiving transportation from any other school districtfor the same period of time.
(Date)*

MonthDayYear
Date
(Signature of Parent or Guardian)*

Clear
Email*
example@example.com
(Daytime Telephone Number)*

WHEN PROPERLY EXECUTED,THISFORMMAY BE ACCEPTED AS ANOFFICIALVOUCHER. THELOCAL BOARDOFEDUCATION MAY PAY TRANSPORTATION AID BASED ON THIS CLAIM PURSUANT TO N.J.S.A. 18A:39-1 and 18A:19-3

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NEW JERSEY STATE DEPARTMENT OF EDUCATION