ACHS&M Bus Funds Request Form

To request bus funds from the ACHS&M please fill out this form and return to:

Ron Luce, Executive Director

Athens County Historical Society & Museum

65 N. Court Street

Athens, Ohio  45701

Date of Visit to ACHS&M:________________________________________

Name of School: ______________________________________________________

Name of teacher/coordinator: ____________________________________________ 

Grade of Students: ____________________

Number of Students: __________________

Number of buses: _____________________

Amount requested: ____________________

Please break down the amount if you know the following:

            Cost of bus driver: ______________

            Mileage cost: __________________

Name the check should be made out to: ____________________________________

Address the check should be sent to: ______________________________________

__________________________________________________________________

Attention:  ____________________________________ 

We will process your bus fund request immediately following your visit, providing we have all the information needed.

Received on__________________

Processed___________________