Flow Meter request form rlbyington@madison.k12.wi.us, Amanda Nagel, Administrative Assistant, Transportation Services (TEP), (608) 442-2897 - Office ANY REQUESTS FOR CHANGES MUST BE MADE IN WRITINGEmail your request to Transportation Services. Fill out the form below on the last school day of each month. MMSD is committed to protecting our community and the environment for a healthier, cleaner, resilient region. x=[SH-{kK2Udd#j9u3TVt. You must submit a separate form for each driver. Local agency NEMT transport services include the following: Local agency NEMT transportation services provided by the NEMT provider include the following: Ancillary NEMT Access Services Applications for 4K bus service will not generally be accepted during the school year except when a family experiences a significant change in circumstances (onset of parent health condition) or moves into the District after the school year has already begun. transportation@madison.k12.wi.us. In addition, s. 121.545(1), Wis. KKteC'XR%J\1>4sYd#)v, P?,\ Waste Strength Certification/Water Balance Form. If you call with less notice and the trip is not urgent, we may not be able to set up your ride. Each private school is required to identify pupils who may qualify for transportation. 2 0 obj The starting pay will be between $24.00 - $33.50/hr. Stats., specifies that "An annual or special meeting of a common or union high school, or the school board of a unified school district, may elect to provide transportation for pupils who are not required to be transported." See Requirements for Alternative Vehicle Drivers for additional information. Transportation to and from an alternate site (i.e. Forms listed below are either Adobe PDF, Microsoft Word or Excel. Our system also found out that Mmsd.transportation.org main page's claimed encoding is utf-8. Learn how MMSD's water reclamation facilities clean our water. The April 1 statutory timeline for submitting an attendance area is critical. If you live less than one and one-half miles away from your attendance area school, and your child is in 4K, you may submit anapplication for bus service. The mileage to and from the eligible service by the most direct route is reimbursable. MMSD provides safe, efficient, and economical transportation for all eligible students residing within the school district boundaries: $5,000 SIGN-ON BONUS FOR NEW SCHOOL BUS DRIVERS. Elementary school-aged students (4-year-old kindergarten through fifth grade) who live in the MMSD and who attend their attendance area MMSD school are eligible for District-provided, yellow bus transportation if their pick-up location (residence or childcare location) is located more than one and one-half (1.5) miles from the attendance area elementary school or they reside in an area identified as an unusually hazardous zone in which transportation is offered. 12. More information can be found here. california wildfires 2019 articles / clicker heroes mobile / clicker heroes mobile Refer to the Authorization Requirements section in the NEMT Services (Overview) for more specific information. Members will access all other NEMT transports through the health plan. rlbyington@madison.k12.wi.us. How to Complete an Expense Reimbursement Form: 1. 2 0 obj Vanko v. Kahl, 52 Wis. 2d 206). Stats., provides: "If the private school and the school board cannot agree on the attendance area, the state superintendent shall, upon the request of the private school and the board, make a final determination of the attendance area.". More information can be found here. Medicaid Transportation Justification Request Form. Laws of Minnesota 2014, chapter 312, article 24, section 45 (Waiver Applications for Nonemergency Medical Transportation Service Providers) The local agency may hold personal mileage reimbursement until a reasonable amount has been accrued before generating a payment. For the before school (morning 4K) and after school (afternoon 4K) runs, 4K students will be picked-up and dropped-off with all other elementary students at the established bus stops. the pupil resides two miles or more from the private school he/she attends; the pupil resides within the private school's approved attendance area; and. Hampshire Reimbursement Requested $100.00 $ $ $ Total Amount Requested: $ To the best of my knowledge and belief, my statements in this Transportation Reimbursement Request Form are complete and true. endobj To be eligible for reimbursement for NEMT transport to a nursing facility on the date of discharge from a hospital if the county has not updated the members living arrangement three months after the month of admission, submit the completed State-Administered Nonemergency Medical Transportation (NEMT) Trip Sheet (DHS 7047) (PDF) and required documentation for fee-for-service (FFS) state-administered NEMT claims when all of the following apply: Facility staff at both the origination (pick-up) and destination (drop-off) facility or medical provider locations must sign the form. % Help protect Lake Michigan by ordering rain garden plants for up to 50% off retail. The client and transporter must determine who will be the payee. (Questions regarding mileage reimbursement for trips that occurred prior to May 1, 2022 can be directed to One Call's Billing Department at 1-855-431-9060.). For Ancillary Access Service Procedure Codes, Modifiers and Payments Rates refer to the Ancillary Services Claim and Rate Information for Counties and Tribes web page. Transportation will begin on the same day as the Districts start date. Only transportation to and from the regular school day is reimbursable. 9th 12th: The District does not generally provide transportation to high-school-aged students (grades nine through twelve). Have your Medicaid ID number, which is on your blue Medicaid card, and appointment information. Our service has detected that English is used on the page, and it matches the claimed language. However, DPI encourages school districts and private schools to work cooperatively for the benefit of all pupils residing in the district, whether they attend public or private schools. a motor vehicle transporting nine or less passengers in addition to the operator; and. www.newlondon.org 134 Williams Street, New London, CT 06320 NLPS Pre-Approval Signature - Must be pre-approved by 10/1/2021 transportation@madison.k12.wi.us. Contact the local county or tribal agency for reimbursement processes. Transport of an Emergency Medical Assistance (EMA) member for the purpose of obtaining routine or preventative medical care or services is not covered. Form 4214, Request for Non-Emergency Medical Transportation (NEMT) Services Instructions for Opening a Form Some forms cannot be viewed in a web browser and must be opened in Adobe Acrobat Reader on your desktop system. Determinations regarding space on existing routes will be made within the first two weeks of the school year and transportation will begin during the third week of the year. RTCP Fact Sheet About the Program Funding We look forward to MMSD Summer Semester 2023! Bob Byington, Transportation Coordinator, Specialized and Alternative. This exemption from the transportation requirement is not permitted for school districts that contain all or part of a first, second, or third class city with a population exceeding 40,000 unless transportation is available through a common carrier. Help protect Lake, Feb 8, 2023, 8:00 AM Mar 31, 2023, 5:00 PM, Hart Park & Western Milwaukee Levee System, Building Information Modeling (BIM) Coordinator, Engineering Aide (Construction Inspector), "How to Plan Your Rain Garden" Workshop (in-person) with Melinda Myers. MMSD sewer overflow alert for February 27, 2023, MMSD's diversity aids us in our success of being a regional protector, The MMSD Spring Rain Garden Plant Sale is now OPEN! Section 121.54(2)(c), Wis. Monthly deadlines are listed on each form. Refer to Out-of-State Medical Services in the NEMT Services (Overview) section of the Provider Manual for information on out-of-state transportation services. The completed form must be returned to us within 30 days of your first visit to the doctor. Stats., "Annually, by April 1, each private school shall submit its proposed attendance area for the ensuing school year to the school board of each school district having territory within the proposed attendance area. ROUTES ARE SUBJECT TO CHANGEOur bus company and school staff will communicate directly with impacted parents/students in advance. 9124 (13k)] - SB44. For all other counties, contact the local county or tribal agency for NEMT transport and service procedures. The rules adopted by the State Board of Education for the transportation of public school students are also applicable to nonpublic school students . The rates are in effect for the 2021 - 2022 fiscal year (April 1, 2021 . View the form in Spanish. 4 0 obj Pursuant to s. 121.54(2)(b)(3), Wis. Pay for current or former state employees will follow the provisions found in the State of Wisconsin Compensation. NH Department of Health & Human Services Fitness and WW Reimbursement Form Print, complete and send back this form to receive your GetFit! This exception is only available for 4K students. La Follette High School - Referendum 2020, Southside Elementary School - Referendum 2020, Southside Elementary School Naming Process, Safety and Student Wellness Ad Hoc Committee, Renaming Ceremony of Milele Chikasa Anana Elementary School, Madison Virtual Elementary Promotion Ceremony, Student and Staff Support connect with community through social media series, Common Core State Standards = Opportunity, What to Expect After Bullying is Reported, Community Events/Activities Submission Form, Guidelines for distribution of non-school related materials, Guidelines for distribution of non-school related materials: Partnerships, School Start & Dismissal Times - All Schools, Principal Screening and Selection Process, Reside within the boundaries of the school attendance area. 2021 Sewer Lateral Workplan Updates. Use the tools in the top toolbar to . For a list of NH Medicaid Fee For Service benefits, visit the Medicaid page or review Form77L. The school district may waive the fee, or any portion of it for any person who is unable to pay. Section 121.54(1), Wis. All Rights Reserved. Waste Strength Certification/Water Balance Instructions. We need your help caring for our rivers and Lake Michigan by managing water where it falls and reducing water pollution. Otherwise Mmsd.transportation.org can be misinterpreted by Google and other search engines. Contact Us: Email: openenrollment@dpi.wi.gov or call toll-free: 888-245-2732, 125 S. Webster Street Madison, WI 53703, Kindergarten, 4 Year-Old Kindergarten, and Early Childhood Education, Transportation and Transportation Reimbursement, Public School Open Enrollment Appeals Information, Habitual Truancy, Failure to Participate (Virtual Charter Schools) and Expulsion, Open Enrollment and Homeless Children and Youth, Open Enrollment Transportation and Transportation Reimbursement, Information About Filing anOpen Enrollment Transportation Reimbursement Claim, Open Enrollment Transportation Reimbursement Data. TRIP contributions are taken directly from your pay before federal, most state and city income and social security taxes are deducted. The school board may extend the notification deadline." For example, a school district may provide transportation for pupils in grades K-8, but not for pupils in grades 9-12. However, beginning with the 2019-2020 school year, a transition will begin through the implementation of a three year phase in plan to accommodate later middle school start times. stream Mailing address: 550 High Street, Suite 1000, Jackson, MS 39201. Information to members must include but is not limited to the following: Local Agency NEMT Coordination Publicly operated transit systems, volunteers, not-for-hire vehicles and ambulance services are exempt from the enrollment requirement and do not need to enroll. Stats., requires alternative vehicles transporting nine or less passengers to meet certain requirements relating to insurance and inspection. I certify that the services described above were received on the dates indicated, that the expenses qualify as valid services Stats., further states: "The attendance areas of private schools affiliated with the same religious denomination shall not overlap unless one school limits its enrollment to pupils of the same sex and the other school limits its enrollment to pupils of the opposite sex or admits pupils of both sexes." -4fW?4b&\e:J3cD,k7"'Cp>IppB>)ZQ5DHh##]KwW?3 ajg-tcv'Pk&z~$(eY',U&DbNJ@>z4H l Dnx} $t~,&r;CqPA9^8)(0n $)aIu",iVg;NN #8JAu@v IjuFm]}O*DV%"WgT= MNRw\$s25z!'Qzc8dz\ h/2f8g1AI`"b tO;SJy@+~it%Kc dUbr~Oe75 DGY@f\F1N#g~O#>L(IV8|rp'Zlh Fx -1\pc9FN?~>E^l+$ogC8)S!d qo=^8trx|+M" kc8RR0']8GILN1DCV|$tr42WaD/)dJ>7Gs ba!c Information for billing can be found in the MHCP Provider Manual under Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service and Rate Information. Plant supplies are limited for this plant sale. to 5:00p.m. ET. Minnesota Statutes, 256B.0625, subd. Be in fifth grade or younger (except in certain areas of Fitchburg). FREE drop-off for your household hazardous waste at one of our permanent or mobile collection locations. Yellow bus transportation is provided to neighborhoods where no public transportation is available. Show details How it works Open the sample tuition reimbursement form and follow the instructions Easily sign the request pdf with your finger Send filled & signed request for reimbursement or save The method of transportation is determined by the school board, rather than by the parent/guardian of the student. Trip documentation must be consistent with Minnesota Statutes, 256B.0625, subdivision 17b which includes the following requirements: Documentation must also include the following: Refer to Noncovered Services in the NEMT Services (Overview) section. For example, here are the calculations for one and two children using the same number of miles and days transported: = the lesser of the Total Mileage Cost or the Maximum Reimbursement. To find a NH Medicaid provider, visit theNew Hampshire MMIS Health Enterprise Portal, and click on find a healthcare provider. Portable Flow Meter Installation Request. Minnesota Statutes, 174 (Department of Transportation) Box 7713, Madison, WI 53707-7713, (608) 246-3265. Trips must be pre-approved. Any forms turned in after the 15 th Our bus company and school staff will communicate directly . The District will not provide transportation to siblings, relatives or friends of the 4K student. If a parent did not request reimbursement at the time of applying for open enrollment, the parent should contact DPI and we will send information about filing a claim. Shortly after the beginning of the school term, DPI will send information about how to file a claim. Work at MMSD and become a part of our team, helping to protect the environment and our community. 4. Please send this completed form TO THE TEACHER ON THE LAST SCHOOL DAY OF EACH MONTH. Step 1: The first step will be to hit the orange "Get Form Now" button. To request transportation reimbursement, complete the Transportation Reimbursement Form (PDF) or call us at 1-888-597-1192. 2 the number and date of this credit and the name of issuing bank must bequoted on all drafts. According to Wisconsin law, a pupil attending a private elementary or high school in Wisconsin, including four- and five-year-old kindergarten,is entitled to transportation provided by the public school district in which the student resides, if certain criteria are met. Alternative vehicles fall into two categories: Section 121.555(2), Wis. Include your full name, employee identification number (if applicable), department, and any other appropriate information that is required in the form so that the recipient will know who to remit the reimbursement to. MMSD is committed to protecting our community and the environment for a healthier, cleaner, resilient region. All NEMT providers must comply with the operating standards for vehicles and drivers according to Minnesota Statutes, 174.29 and 174.30. Stats., specifies that the provisions of state law requiring school districts to provide transportation to eligible public and private school pupils "do not apply to pupils who reside in a school district that contains all or part of a city unless the school they attend is located outside the city but within the boundaries of the school district." Rather, the District and City of Madison work cooperatively to ensure that Madison Metro Transit routes are available to students as a primary means of transportation. The local county human services agency must use one of the following codes for the provider to receive reimbursement for state-administered NEMT transports (verify these living arrangement codes through the member eligibility request in MNITS): Exception: If the county living arrangement is not updated three months after the month of admission Yellow bus transportation for the school year will align to the Districts calendar. Use of this encoding format is the best practice as the main . Individuals enrolled in Medicaid Care Management should call their health plans transportation phone number listed on the back of their health plan Member Identification Card. Minnesota Statutes, 256B.0625, subd. Minnesota Statutes, 174.29 - 174.30 (Coordination of Special Transportation Service) View the form in Spanish. Parents of students attending a private or parochial school other than those identified above may be eligible to receive reimbursement through a parent contract. mmsd transportation reimbursement form In order to address this particular aid "cliff," created when districts tip just over 745 pupils and thus no longer qualify for any additional aid at all, Walker's proposal creates a new tier of Sparsity Aid . **Please note: effective September 1, 2020, CTS will no longer be providing non-emergency transportation services to NH Healthy Families members. For transportation assistance, call Blue Cross Complete's Customer Service at 1-888-987-5832. %PDF-1.7 This could include a state-administered mode or level of transport. The time and distance to school. When MMSD was compared to 16 comparably sized metro areas, the Milwaukee sewerage district ranked as the least-expensive operation. 18a (Access to medical services) Have demonstrable financial need, including qualifying for free or reduced lunch. Weekly form submissions are recommended to provide a consistent payment cycle and avoid payment delays. Reside more than one and one-half (1.5) miles from their attendance area school. Health Risk Assessment Complete your health risk assessment so we can help provide better health services and coordinate the care you receive. Beginning May 1, 2022, NH Medicaid recipients who are in the states Fee for Service program get their transportation services through Coordinated Transportation Solutions (CTS). The calculated amount allowed is the maximum amount MHCP will reimburse the local agency. These applications are due during the summer before your child starts 4K. Provider Type Page Links | Accessibility | Privacy | Cookie | Site Map. Additional trips to and from school for extra-curricular activities, parent-teacher conferences, etc. The local county human services agency updates the members living arrangement code in KEPRO and must indicate that the member resides in a nursing facility. Please call at least 48 hours in advance to request a ride. WCA has 8 office locations and proudly employs about 800 tree workers and arborists. View the form in Spanish.Care Management PHI Authorization Form This document gives us permission to share your information with healthcare providers and community organizations, as needed, to manage your care. District-provided Metro passes are available for students who: 6th 8th: Currently, this also applies to middle-school-aged students (grades six through eight). The record does not include your medical records.Request for Confidential Communication Form Make a request to receive communications with protected health information (PHI) by alternative means or at another location.Request for Release of Information Form This form is used to authorize WellSense to release your PHI to you or to another organization. County or Tribal Agencies Visit the Milorganite website for lawn and gardening tips. Learn how MMSD's water reclamation facilities clean our water. Stats., permits school districts and private schools to provide pupil transportation services using "alternative vehicles," or vehicles other than school buses. District-provided Metro passes are available for students who: 6th 8th: Currently, this also applies to middle-school-aged students (grades six through eight). The structures of governing bodies of private schools may vary. There are three variants; a typed, drawn or uploaded signature. rlbyington@madison.k12.wi.us, Amanda Nagel, Administrative Assistant, Transportation Services (TEP), (608) 442-2897 - Office Get Government & Politics updates in your inbox! 9th 12th: The District does not generally provide transportation to high-school-aged students (grades nine through twelve). endobj Register your chi Decide on what kind of signature to create. Otherwise, reimbursement will be paid on the next payment cycle (in two weeks). Create your signature and click Ok. Use the NH Medicaid Non-Emergency Transportation Program if you need a ride to, or help paying for gasoline to travel to a NH Medicaid covered service. Click the appropriate link below for more information. 4 0 obj Members may require a higher mode of NEMT transport for the return trip. jRVyM$Q*{4!{MexMED$.jPV~p.H!Cs.|Mc@ %8B Claims are paid by miles, not by children. Whether similar and equivalent service is provided to other pupils eligible for transportation. The transportation reimbursement rate for the 2021-2022 school year is $0.56 per mile up to a maximum of $5.00 per day. You may apply for all types of assistance we offer, including cash, Supplemental Nutrition Assistance Program (SNAP) and child care. And avoid payment delays for any person who is unable to pay file claim... Statutory timeline for submitting an attendance area school orange & quot ; Get form Now quot... Or friends mmsd transportation reimbursement form the 4K student financial need, including cash, Supplemental Nutrition assistance (... Transportation @ madison.k12.wi.us card, and click on find a healthcare provider April 1 statutory for! Overview ) section of the school term, DPI will send information about to... April 1 statutory timeline for submitting an attendance area school service procedures Print, Complete the reimbursement., 2021, helping to protect the environment for a list of NH Medicaid Fee for benefits! Or tribal agency for reimbursement processes staff will communicate directly eligible to receive reimbursement through a parent.! May be eligible to receive reimbursement mmsd transportation reimbursement form a parent contract, 174 ( Department of )! Access all other counties, contact the local county or tribal Agencies visit the Medicaid or. Or call us at 1-888-597-1192 are also applicable to nonpublic school students drawn uploaded! Please call at least 48 hours in advance to request transportation reimbursement, the. A parent contract please call at least 48 hours in advance to request transportation reimbursement, Complete and send this! A school District may waive the Fee, or any portion of for. Are recommended to provide a consistent payment cycle and avoid payment delays the Program Funding we look to! Decide on what kind of signature to create for each driver a private or parochial other... By managing water where it falls and reducing water pollution shortly after the 15 th our bus company school. Submit a separate form for each driver CHANGEOur bus company and school staff will communicate directly NH Medicaid provider visit... 4K student your GetFit taken directly from your pay before federal, most State city... Encoding is utf-8 trip is not urgent, we may not be to. Section of the provider Manual for information on Out-of-State transportation Services 4K student portion of it for any who. Parents of students attending a private or parochial school other than those identified above may be eligible to receive GetFit. About the Program Funding we look forward to MMSD Summer Semester 2023 Services Overview... Word or Excel qualifying for free or reduced lunch the 15 th bus! The form in Spanish Vehicle Drivers for additional information applicable to nonpublic school.! Term, DPI mmsd transportation reimbursement form send information about how to file a claim the care receive... For each driver WI 53707-7713, ( 608 ) 246-3265 Risk Assessment so we help... Rules adopted by the most direct route is reimbursable site Map drop-off for your household hazardous waste at one our. And coordinate the care you receive route is reimbursable how MMSD & # x27 ; s claimed is... For vehicles and Drivers according to minnesota Statutes, 174.29 - 174.30 ( Coordination Special! Health Services and coordinate the care you receive rivers and Lake Michigan by ordering rain garden plants for up a. Not by children K-8, but not for pupils in grades K-8, but not for in... There are three variants ; a typed, drawn or uploaded signature the before! Enterprise Portal, and click on find a healthcare mmsd transportation reimbursement form ( 608 246-3265... A healthier, cleaner, resilient region, relatives or friends of the school District may waive the,! Teacher on the last school day of each month local agency maximum of $ 5.00 day! Also found out that Mmsd.transportation.org main page & # x27 ; s claimed is. Pdf-1.7 this could include a state-administered mode or level of transport any person who unable! Need, including cash, Supplemental Nutrition assistance Program ( SNAP ) and child care part of our team helping... Transportation to and from the regular school day of each month Byington, transportation Coordinator, Specialized Alternative... Relatives or friends of the school term, DPI will send information how! Services ) have demonstrable financial need, including qualifying for free or reduced lunch to a of! To meet certain Requirements relating to insurance and inspection our team, helping to the! Certain areas of Fitchburg ) Complete an Expense reimbursement form: 1 pay before federal, State. Complete and send back this form to the doctor of our permanent or mobile collection locations relating... To Out-of-State Medical Services ) have demonstrable financial need, including cash, Supplemental Nutrition assistance Program ( SNAP and. Complete the transportation of public school students are also applicable to nonpublic school students can be by. Cash, Supplemental Nutrition assistance Program ( SNAP ) and child care other NEMT transports through health. The Program Funding we look forward to MMSD Summer Semester 2023 Services and coordinate the care you receive for driver! Company and school staff will communicate directly Mailing address: 550 High Street, London... Rights Reserved most State and city income and social security taxes are deducted and. Hampshire MMIS health Enterprise Portal, and click on find a NH Medicaid Fee service! Id number, which is on your blue Medicaid card, and appointment information cycle ( in weeks! 2D 206 ) with impacted parents/students in advance step will be paid on the last school day is.! Of Fitchburg ) Wis. 2d 206 ) could include a state-administered mode or level of transport section 121.555 2! Help protect Lake Michigan by managing water where it falls and reducing water pollution all NEMT providers must with. For service benefits, visit the Medicaid page or review Form77L 2 0 obj Vanko Kahl... ( i.e communicate directly the regular school day is reimbursable for up to maximum... Within 30 days of your first visit to the operator ; and agency NEMT! Free or reduced lunch Wis. all Rights Reserved NLPS Pre-Approval signature - must be returned us! To Complete an Expense reimbursement form: 1, Wis protecting our community and name... Send information about how to file a claim mmsd transportation reimbursement form 06320 NLPS Pre-Approval signature - must be to... Contact the local agency it for any person who is unable to pay ( except in certain of... ( c ), Wis. all Rights Reserved for service benefits, visit Medicaid... Weeks ) Supplemental Nutrition assistance Program ( SNAP ) and child care not by children Alternative... Alternative vehicles fall into two categories: section 121.555 ( 2 ) ( c ) Wis! Must submit a separate form for each driver in effect for the return trip eligible for.!, or any portion of it for any person who is unable to pay of transport Board. For transportation assistance, call blue Cross Complete & # x27 ; s Customer service at 1-888-987-5832 section (! % off retail and it matches the claimed language ) or call at. Operating standards for vehicles and Drivers according to minnesota Statutes, 174.29 and 174.30 be fifth... 174.30 ( Coordination of Special transportation service ) View the form in Spanish the last school of... On find a healthcare provider within 30 days of your first visit to the operator ; and service benefits visit! Household hazardous waste at one of our team, helping to protect the for... School day is reimbursable higher mode of NEMT transport and service procedures the. Dpi will send information about how to file a claim, Microsoft Word or.. Grades nine through twelve ) who will be the payee if you call with less and... The Milwaukee sewerage District ranked as the Districts start date by Google and search! Submitting an attendance area mmsd transportation reimbursement form critical Links | Accessibility | Privacy | Cookie | site Map is committed protecting!: the District does not generally provide transportation to and from an alternate (. Rain garden plants for up to a maximum of $ 5.00 per day the name of bank..., relatives or friends of the school term, DPI will send information about how to Complete an reimbursement! The 15 th our bus company and school staff will communicate directly impacted., parent-teacher conferences, etc, the Milwaukee sewerage District ranked as the Districts start date a part of permanent... The care you receive receive your GetFit schools may vary to 50 % off mmsd transportation reimbursement form trip is not urgent we... Ms 39201 parochial school other than those identified above may be eligible to receive your GetFit begin the... Service procedures, relatives or friends of the 4K student healthcare provider mobile collection locations pay will be on!, 174.29 - 174.30 ( Coordination of Special transportation service ) View the form in Spanish to MMSD Summer 2023! Passengers in addition to the doctor, 174 ( Department of transportation ) Box 7713 Madison! Part of our permanent or mobile collection locations Mmsd.transportation.org main page & # x27 ; s claimed encoding is.... Fifth grade or younger ( except in certain areas of Fitchburg ) please send this completed form receive! Year ( April 1, 2021 are deducted ( 1.5 ) miles from their attendance area school # x27 s... Summer Semester 2023 ) and child care form submissions are recommended to provide consistent. For reimbursement processes must determine who will be paid on the last day! Extend the notification deadline. Complete the transportation reimbursement, Complete the transportation of public students... For reimbursement processes shortly after the 15 th our bus company and school staff will directly... Or mobile collection locations are recommended to provide a consistent payment cycle and avoid payment delays and 174.30 form 1... Form submissions are recommended to provide a consistent payment cycle ( in two weeks ) form... Or review Form77L local county or tribal agency for reimbursement processes demonstrable financial need, including cash, Nutrition! Is reimbursable direct route is reimbursable PDF, Microsoft Word or Excel c ), Wis all of...