Address:
Postcode:
Telephone: / Mobile:
DOB: / Male/Female:
Email:
How old will you be on the 1 September 2015: / 16-18 19+ If so please contact college first for funding approval before submitting form
Which County does your household pay council tax to?
Course Details:
Name of College/Sixth form you will be attending:
Is this the 1st, 2nd or 3rd year of study? / 1st 2nd 3rd
What course(s) are you attending?
Route details. Photos are required for Train travel only. Please see Overleaf for more information.
From: / To:
If known, please advise which bus service you require or specify train station. Please note that only the most cost effective transport is provided. No changes will be made to passes once issued. Photo ID cards must be retained throughout the duration of College life.
Special Educational Needs
Do you have special educational needs? / Yes No
If yes, please give details:
Are you able to travel independently? / Yes No
Please provide any further information that might be useful and relevant to your application.
Declaration:
I have read the policies; I certify that the information given is correct and that the applicant is not in full-time employment including Modern Apprenticeship. I agree to abide by the conditions and terms relating to transport arrangements.
Data Protection Act 1998 - I give my consent to the information on the form being passed to or shared with the Transport Operators, Herefordshire Council and/or the Herefordshire Partnership Colleges for the purpose of organising transport.
We will not be able to process your application if you do not agree.
Signed: / Date:
Student/parent/guardian:
For Office Use Only - Updated 28 May 15 GB
FE Number / SEN? / Yes/No / Date: / Rider no:
Herefordshire Council Tax Payer? / Yes/No / Home Local Authority: / Gloucestershire / Monmouthshire / Powys / Shropshire / Worcestershire
Contribution Attached / Yes/No / Paid by / Parent / B / Home Local Authority
Balance due from / Herefordshire / College / Home Local Authority / Home Local Authority refusal letter? / Yes/No
College Authorisation: / Home Local Authority Authorisation
Contract(s) / Assessed by:
Applying for Post 16 Transport 2015-16
Please enclose payment of £265 for theAutumn term. In due course £265 for the Spring term and £205 for the Summer term. Cheques are to be made payable to Herefordshire Council. You can apply for a travel pass before you have been accepted into College. A full refund of that payment will be permitted before term commences if you, subsequently, do not require a travel pass.
NB You must allow up to 28days for the issuing of a travel pass and no refunds for travel expenses within that timescale will be made. Refunds are only permitted where the 28 days, following full payment for any travel pass, has been exceeded. Passes are to be collected from the College following full payment each term.
Do I need a photograph?
Train passes require a photograph. Please ensure you have one ready for when you collect your pass from College. Please do not send them in with your application.
Train passes
Any student provided with a train pass, must keep the travel pass and photo ID together.
NB The pass and the photo ID must have matching numbers. Please ensure that you retain the photo ID card for the duration of your time at College.
Payment request for each term.
Payment request letters will be sent out approximately six weeks before the end of each term. Details of how to pay are detailed in the payment request letters. Once a pass has been paid for; please allow up to 28 days for the pass to be issued to College.
Students Claiming a Bursary from the College
All Bursary transport applications should be sent to the appropriate Collegewho will then forward the transport application to the Passenger Transport Office.
If you change Colleges during the academic year you must resubmit an application form.
Lost passes
These are charged for at a non-refundable rate as shown on our webpage. During any time when a pass has been lost; no reimbursement will be given for additional fare costs.