Application for Student Travel Assistance (Age 16-19)

Please note:

The transport you are applying for will be considered under the Post 16 Travel Policy and/or the Spare Seats Policy
If you are made an offer of transport assistance, you will be asked to pay a termly contribution towards the cost which can be paid in instalments
An invoice and photo application will be sent to you . When your payment and photo application have been received and processed, we will post the termly pass to your home address
Required fields are marked *

Student Information

Title
Surname *
Forename *
Date of birth *	dd/mm/yyyy
Permanent address *
Address line 2
Address line 3
Address line 4
Town *
County *
Postcode *
Home telephone *	01111 123456
Email address
Does the student have any special needs?	Yes No
The student has a current statement of special needs/EHCP
The student had a previous statement of special needs/EHCP
The student has exceptional circumstances to be considered for transport (This may will require supporting evidence from a medical and/or health professional. We will contact you if this is needed)
Is there any additional information we need to know?Please provide details.
Are you moving between June 1st and August 31st? *	Yes No
Address *
Address line 2
Address line 3
Address line 4
Town *
County *
Postcode *

School or College Information

1) Please provide exact course title (from school/college website or prospectus e.g. A Levels, Diploma etc) *
What is your current high school? *
School or college to be attended *

2) Please list the A levels or Subjects/Levels. If this is a course with only one subject or level, please fill the left over boxes with NA *
(Please show subject(s) and level(s))




3) What will these qualifications achieve in the long term? (e.g. Career in Joinery; Degree in Biomechanics; Apprenticeship in plumbing)

4) Please provide the name of any alternative nearest post-16 provider you may be considering or any further information relevant to your application

Course number	(college students only)
Starting date of course *	Click/Tap box for calendar
Starting date of transport	Click/Tap box for calendar
Preferred method of transport	(if known)
Route Number	(if known)
Duration of course *	(or years remaining of course if presently in attendance. Transport will be set up for the duration stated.)
Student ID	(if known)

Parent or Carer Information

Only required if surname and / or address details are different to applicant details above
Title
Surname
Forename
Address
Address line 2
Address line 3
Address line 4
Town
County
Postcode

Terms and Conditions

I agree that all the information that I have given is correct. * (tick to confirm)
I understand that if a travel place is offered, Terms and Conditions will apply. * (tick to confirm)
I understand that transport is only provided to the nearest sixth form or post 16 centre * (tick to confirm)

Please ensure you make a note of the reference number provided on the next screen