To apply for free or reduced price transportation, complete, sign and return the application to the Student Srvs. Department (Bus Passes), Jefferson School District, 1219 Whispering Wind Dr., Tracy, CA 95377
· Foster Child: Use a separate form for each foster child. Enter income received for child’s personal use. Be sure to sign form.
· Food Stamps, FDPIR or CalWorks (formerly AFDC) households: Enter names and schools of eligible children. Give case number for each child. Be sure to sign form.
· All Other Households: Enter names of all children and all adults living in household. Enter school names for children attending school. Give ALL household income by source. Be sure to sign form. Enter signer’s social security number. Only one application is needed per household. If you need help completing this form, please call the Transportation Office at (209) 834-6109.
List all adults whether or not they have income. List gross earnings and other income received last month by each household member. If any amount last month was more or less than usual, enter usual income. If not monthly, state (after slash /) how often paid. If there is currently no income, enter zeroes (0). Attach copies of any/all pay stubs or other proofs of gross income . Applications will be returned if they are not submitted with acceptible verification of income documentation.