HANDS up SURVEY: HOW DO YOU USUALLY MOST OFTEN Travel to SCHOOL?

Active Journeys Application Form

The information provided in this application form will be used to assess and select schools for involvement in the Sustrans Cymru Active Journeys programme. We encourage you to complete all of the questions in full and submit your application to

School Name:
Address: / Head Teacher:
Head Email:
Postcode: / Head Tel:
School Email: / No.on Roll:
School Tel: / School URN: / Not sure? Search here

You are invited to identify two ‘Active Journeys Champions’ to be designated contacts & lead the project:
Name: / Name:
Email: / Email:
1.Please read the Active Journeys Agreement which is part of the application pack and acknowledge that you understand and accept the commitments required by the school during the Active Journeys programme.
Place an‘x’ in the box to give acknowledgement and acceptance of commitments required:
2.Please survey pupils in Years 3, 4, 5 & 6 on “How do you usually [most often] travel to school?” using the Hands Up Survey provided in the application pack and insert results below:
Date of Survey: / Number of Pupils Surveyed:
Mode: / Percentage: / Mode: / Percentage:
Car / % / Park & Stride / %
Walk / % / Bus / %
Cycle / % / Train / %
Scoot/Skate / %
3. Provide an estimation of the percentage of all pupils who live within 2 miles from the school: / %
4. Has your school had any previous involvement with Sustrans? Place an ‘x’ in any relevant boxes or add any others not listed:
Bike It / Big Shift / Bike to School Week
Big Pedal / School Mark / Smarter Journeys
Downloaded LNF resource
5. Identify any organisations/partners that you may have worked with in the last three years to promote safety, healthy lifestyles, sustainable travel or environmental issues:
Junior Road Safety Officers [JRSO] / Healthy Schools
Local Authority Road Safety Team / Eco Schools
Police / PCSO / Welsh Cycling
Living Streets / Others - please name:
6. Identify any walking, scooting or cycling training that pupils have participated in during the last three years. Place an ‘x’ in any relevant boxes along with the date and who provided the training:
Training: / x / Date: / Provider:
Kerbcraft
Safe Scooting Training
Balance Bikes
National Standard Cycle Training
7. Summarise any actions, activities, events that your school currently undertakes, or has undertaken, to promote walking, scooting and cycling to school during the last three years:
8. Identify and briefly explain the main barriers affecting the participation levels of active travel to your school? Please add any other issues that are specific to your school as this greatly helps us to understand issues & identify potential delivery strategies.
Inadequate infrastructure e.g. paths/pavements / Strong car usage culture
Traffic issues e.g. congestion, parking, speeding / Challenging local geography e.g. steep hills
Lack of safety awareness / training / Bike maintenance issues
Low bike/scooter ownership / Lack of local route planning knowledge
9. Please use this space to provide any additional information to support your application such as your schools motivations for becoming an Active Journeys School or what you would like to achieve through the project: