Travel Application Form for Pupils under the age of 16

Before completing the form, please check your entitlement to free transport.


Pupil's Ethnicity:
Pupil's First Name(s) (in full):
Pupil's Surname:
Pupil's Gender

Pupil's Permanent or New Home Address	Please Enter Here
Postcode:
If Primary age please enter height (cm's):
Receipt of Free School Meal
Maximum Tax Credit
A photocopy of the certificate can be sent shortly to the address at the end of this form	I Agree

Pupil's date of birth: (dd/mm/yy)
Parents contact name:
Tel no.
Mobile Number
Email*

Name of School
Date of Admission (dd/mm/yy)
If not the 'designated' or 'nearest' school for your home address, please state reasons for this:	Please Enter Here
I have read the Guidance Notes and would like to apply for a Vacant Seat	I Agree

Change of Address Applications Only
If application is because of change of address, please state previous address and date of move and ensure new address is completed at the top of this form.
Previous home address:	Please Enter Here
Postcode:
Date of move: (dd/mm/yy)

PLEASE NOTE THAT THE INTEGRATED TRANSPORT UNIT WILL DECIDE UPON THE TYPE OF TRANSPORT PROVIDED.
Please State the Preferred Boarding Point if Known
Please indicate required journeys	Both AM journey only PM journey only

Name of school previously attended
Date of leaving: (dd/mm/yy)
CERTIFICATION BY PARENT/CARER
I declare that I have read the information and agree to the conditions. I will notify the County Council of any changes to these details in the future. I understand that my address details may be shared with the service operator for the purposes of the ticket distribution and a photo may be required. I understand that pupils without a pass may be refused transport.
Please Confirm*	I Agree
Additional Information	Additional Information
Click Button to Submit form
Please send any supporting evidence to - The Education Travel Team, Worcestershire County Council, County Hall, WORCESTER

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This page was last reviewed 24 May 2013 at 17:43.
The page is next due for review 20 November 2014.

Travel Application Form for Pupils under the age of 16

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