School Transport - Application for School Transport on Medical Grounds

• Published date: 24 October 2019
• Issuer: Department of Education

Medical Certificate for Completion by a Registered

Medical Practitioner

APPLICATION FOR SCHOOL TRANSPORT ON MEDICAL GROUNDS

1 Name of School __________________________________________________________

2 Name of Child 3 Date of Birth _________________

4 Address _________________________________________________________________

5 Nature of the child's illness or disability _________________________________________

________________________________________________________________________

6 Degree of severity _________________________________________________________

________________________________________________________________________

7 Probable duration of the illness or disability______________________________________

8 Recent hospitalisation for this illness or disability - if any ___________________________

I HEREBY CERTIFY THAT DUE TO HIS/HER ILLNESS/DISABILITY, THIS CHILD WOULD

BE UNABLE TO ATTEND SCHOOL DURING THE PERIOD STATED AT (7) ABOVE

UNLESS TRANSPORT WERE PROVIDED.

Signed Date _________________

Qualifications and Occupation _________________________________________________

Address Phone No _____________

NOTES

1 It is necessary to have this form fully completed in order to assist the Department in

considering the application for transport under the School Transport Scheme.

2 It should be clear that transport is not allowed unless the Department is fully satisfied that

the child concerned could not attend school, unless conveyed by transport.

This form should be returned to:

Department of Education and Skills, School Transport Section, Portlaoise Road, Tullamore, Co Offaly.