Poway Unified School District
Youth in Transition
Mileage Reimbursement Log
Student(s) Name:
___
School:
Parent Name:
________________________
Starting Address:
________________________
Total mileage per on-time day:
Date
Parent Contact Number:
Miles – One Round
Trip per on-time
school day
PUSD USE ONLY
On-time/Attend
I declare under penalty of perjury under the laws of this state that the information provided here is true
and correct and of my own personal knowledge and that, if called upon to testify, I would be
competent to testify.
By:
Date
Parent in Transition
Date
Poway Unified School District Office of Youth in Transition Representative