1. Form 17-4


Form 17-4

                  
May 1998
TRANSPORTATION CLAIM FORM – SPECIAL NEEDS STUDENTS
For the month of
Name of Claimant _______________
Name of Student
Name of School
 
Number of Days Transported Number of Km Transported per Day
            
Calculation
(No. of Days) X (No. of kilometers)     X (rate per AP 500 Appendix – Schedule of Fees and Rates)
Total Amount
     
Claimant/Teacher Assistant Signature   Date

 

 
 
 

     
Principal’s Signature   Date

 

 
 
 

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