TECHNICAL ASSISTANCE NOTE
No. T-05-14
Contact:
School Business Services
Kay Kanupp
School Transportation Management Section
Department of Education
(850) 245-9795
John L. Winn,
SC 205-9795
Commissioner
DATE:
March 24, 2005
TO:
School District Transportation Directors
FROM:
Charlie Hood, Director
School Transportation Management
SUBJECT
:
Medical Examination Forms (ESE 479) for 2005-06
Ensuring continued access to educational programs requires an adequate supply of qualified school
bus operators. It is time to request Medical Examination Forms (ESE 479) for school bus operators
for the 2005-06 school year. We have attached a request order form to be completed and returned to
this office by April 1, 2005.
If we do not receive your completed request order by April 1, 2005,
your district will automatically receive the same number of forms as last year.
We anticipate
sending out the forms for 2005-06 by early May. The forms will be shipped via the
DOE
Distribution Center
. There is no longer an option of having them sent quarterly. You will receive
the amount requested for the year in one shipment. If your district mail is sent to a post office box,
someone will need to pick them up from the post office.
If you need additional Medical Examination Forms after receiving your shipment, you will need to
order them from the Bureau of Program Planning and Development, Division of Workforce
Development, 325 West Gaines Street, 644 Turlington Building, Tallahassee, Florida 32399-0400. If
you wish to speak with someone in that section, please call Ms. Linda Lewis at 800-342-9271. The
price for each additional form is $.10, and the minimum order is 25 forms.
If you have any questions or need more information, please call Kay Kanupp at 850-245-9795 or
email to kay.kanupp@fldoe.org.
CH:kk
Attachment: Order Request for Medical Examination Forms
cc:
?
District Superintendents (without attachments)
Charter Schools
Linda Lewis
______________________________________
______________________________________
______________________________________
Medical Examination Forms
Order Request
The ___________________________________ School District is requesting ____________
Medical Examination Forms (ESE 479) for the 2005-06 school year.
Annual number
of anticipated
drivers in daily
service for
2005-06
Annual number
of anticipated
substitutes for
2005-06
Annual number
of anticipated
other drivers
(teachers, coaches,
technicians, or
volunteers)
for 2005-06
Annual number
of anticipated
trainees for
2005-06
Total number
of anticipated
forms needed
for 2005-06
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Signed:
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Position:
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Date:
The forms will be delivered to a physical address only! If your address is a Post Office
Box, someone from the district will be required to pick them up from the Post Office.
Return by April 1, 2005, to:
Department of Education
325 West Gaines Street
1114 Turlington Building
Tallahassee, FL 32399-0400
Attn: Kay Kanupp
FAX (850) 245 -9935
