app_transport_over16 by nuhman10

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									                                                                                                                             2010/11




Transport awards — For students over 16

Application form for travel for new students between 16 to 19 starting full-time courses in Septem-
ber 2010


Please read the notes when you fill in the form                                                        OFFICE USE ONLY

                                                                                                Acknowledged




Part A (To be completed by all students)                                                          Registered      Date

1. Surname                                                                                                        Initials



2. First Name(s)

                                                                                                Residence
3. State title             Mr             Mrs              Miss                 Ms
                                                                                                Age

4. Marital Status                                                                               Course

                                                                                                College
                                          Day          Month             Year
5. Date of Birth                                                                                Progression

                                                                                                Fully completed form

6. National Insurance Number                                                                    Nearest Establishment

                                                                                                Mileage/Dangerous Routes
7. Country of birth
                                                                                                Denominational

                                                                                                Entitled to free transport
8. (a) Home Address
                                                                                                Date & Initials




                                                             Post Code


(b) Telephone Number
    (including STD code)


(c) Which Borough/District do you/your parents pay council tax to?




(d) Have you always lived at the address stated in 8(a)?           Yes                   No

                                                             Day          Month          Year
   If NO please state the date you started to live there


(e) If less than 3 years give previous address(es) and date(s) of residence from 1.9.2007
       Address                                                         From            To




                                                                                     1
                                                                                                                       Office use only
   (f) Address of parent/guardian if different from 8(a) above




                                                                                                                       TRANSPORT AWARD


                                                                 Post Code                                  Contract



  9. Details of the last three schools or colleges you went to                                              Operator
                                                                                              Was it full
                                                       From                  To               or part       Date &
      Name of school or college and town               Month        Year     Month     Year    time?        Initials




     Previous Study
  10. If you have left the last college or school before the end of the academic year 2009/10 please
       give details;




  11. Current College and
       course details


(a) Name of school or college
    you will attend




(b) Which campus/site is your
      course at?




(c) Exact course title and
    level of course, for
    example NVQ 3



(d) Subject(s), for example
    Maths, English




   (e) Total length of the course            Month   Year                    Month    Year
                                    Starts                            Ends




                                                                                2
Part B       Transport (to be completed by student)

1. Distance from home to School/College by the shortest available route?                      Single
                                                                                              journey

2. Suggested method of transport (The final method is decided by Thurrock Council)

    TRAIN - From: Station                                          To: Station




    BUS - From: Bus Stop Name               To: Destination                             Company ie TWY      Service No. ie 15




Part C       You and your parents (if applicable) must fill in this section

This Authority is under a duty to protect the public funds it administers and to this end may use the information you have pro-
vided on this form within this Authority for the prevention and detection of fraud. It may also share this information with other
bodies administering public funds solely for these purposes.

Declaration
I have not previously applied to Thurrock Council for travel for the year beginning 1 September 2010. If you give me a travel
award and I do not go to the school or college for any part of the period covered by the travel award, or if I stop living in your
area, I will refund any money you ask me for (including a proportion for season tickets, if applicable). If you are under 18 we will
send the bill to your parent or guardian.

I authorise Thurrock Council to make enquiries about the validity of the information provided on this form from other central
and/or local government bodies, as deemed appropriate by the Authority and hereby consent to the disclosure of any informa-
tion sought in accordance with the foregoing for the purposes of the Data Protection Act 1998.

Behavioural Agreement
I acknowledge that should my behaviour be deemed inappropriate and a health and safety threat to other people, my transport
will be suspended or withdrawn.

1. Student                                                                 Date
              Signed


2. Parents/Guardian
                                                                           Date
     Signed (father)

  Full Name (father)




                                                                           Date
    Signed (Mother)

 Full Name (Mother)




                              Closing date for the academic year 2010/2011

                                                        1st August 2010
                              Please note

                              If we receive forms after this date, we cannot guarantee transport
                              will be arranged for the start of the term.



                                                                                     Return this form to your school or college


                                                                      3
Part D (Your tutor or welfare officer at the college or school must fill in this section              Office use only
before the form is returned).

1.(a) The student has been offered and accepted a definite place on the course shown in part A
      question 12.


(b) The student’s course does not receive any funding, for example from the European Social Fund or
    Essex Training and Enterprise Council




2.(a) Will late travel be needed?               Yes              No

 (b) If YES please complete

       Days & Dates                   Site                Finish times             Reason




3. College dates

  If the college is outside the boundaries of Thurrock or Essex, please give the term dates
                                    From                                     To
         Autumn

          Spring

        Summer

4. What level is the course?        Further Education                 Higher Education


5. Is the applicant starting the course late?     Yes               No


        If YES, please give the first day of attendance




Your signature                                                     Date

         Name

       Position
                                                                          College or school stamp




     Please tick which evidence you are submitting?

     Copy of offer Letter              School Stamp
                                       (please use the box)




You must sign the application form before it is posted to:

Awards & Benefits Section,
Thurrock Council,
Civic Offices,
New Road,
Grays,
Essex,
RM17 6SL.

Closing date: 1st August 2010

                                                                             4
                             South Essex College
                                 Transport Booking Form
                           (To be returned by all students attending
                                     South Essex College)


Name : ____________________________                 D.O.B. ________________________

Campus : Thurrock / Basildon                        Contract No : _____________________
(please delete as appropriate)

Boarding point :
_______________________________________________________________________
(for information please see overleaf)

Course Title : ____________________________ Duration: ________________________


                Please attach and return with the completed application form.
                        FAILURE TO COMPLETE AND RETURN THIS
                         FORM WILL RESULT IN NO TRANSPORT
                                   BEING PROVIDED.

                        (Please see overleaf for boarding points)
          ADDITIONAL INFORMATION (FOR SPECIAL NEEDS STUDENTS ONLY)

Please tick the boxes that apply to you or your difficulty/needs

Travel Sickness          Large Wheelchair               Crutches
Hearing Impaired         Wheelchair                     Walker
Trained Nurse            Behavioural Difficulties       Blind/Sight Difficulties
Epilepsy                 Seating - Harness              Autistic

Do you take any special medication for your disability ? If yes please state which
medication you are taking below :

____________________________________________________________________
                               South Essex College
          Thurrock Woodview & Nethermayne Campuses
                                        Contractor:
TC0001 (Woodview)                    TC0002 (Woodview)                      TC0047 (Woodview)
Basildon, Five Bells                 Aveley, Purfleet Road                  Chafford Hundred, Medical Centre
Corringham, Lampits Hill             Aveley, High Street                    Lancaster Road/Anne Heart Close
Corringham, Giffords Cross Road      Aveley, Mill Road                      Mayflower Road/Campus Bus Stop
Corringham, Springhouse Road         South Ockendon, Foyle Drive            Chafford Hundred Station
Corringham, Williamsons Way/         South Ockendon, Derwent Parade         Chafford Hundred, Burghley Road
Southend Road                        South Ockendon, Arisdale Avenue        Palmers College
Stanford le Hope, Fourth Avenue      South Ockendon, Tamarisk Road          Sth Essex College, Woodview Campus
Stanford le Hope, Third Avenue       (opp Station)
Stanford le Hope, Second Avenue      South Ockendon, Tamarisk Road
Stanford le Hope, Abbots Drive       o/s 134-138
Stanford le Hope, Burgess Avenue     South Ockendon, Buckles Lane
Stanford le Hope, The Green          South Ockendon, Ford Place
Stanford le Hope, London Road        North Stifford, Harvester Restaurant
Orsett Cock PH                       Sth Essex College, Woodview Campus
Sth Essex College, Woodview Cam-
pus




TC0056 (Woodview)                    TC0061 (Woodview)                      TC0010 (Nethermayne)
Purfleet, Uplands Estate             East Tilbury, Stanford House           Tilbury, Civic Square
Purfleet, Centurion Way              Linford, George & Dragon               Chadwell St Mary, Riverview
Purfleet, Rail Station               Horndon Primary School                 East Tilbury, Linford Shops
Purfleet, Lockyer Road               Bulphan Village Hall                   Stanford le Hope, Rail Station
West Thurrock, Second Avenue         Sth Essex College, Woodview Campus     Stanford le Hope, The Sorrells
West Thurrock, Southview Road                                               Stanford le Hope, Southend Road
West Thurrock, Mill Lane                                                    (junction Second Avenue)
Palmers College                                                             Stanford le Hope, Mackley Drive
Sth Essex College, Woodview Cam-                                            Corringham, Lampits Hill
pus                                                                         Sth Essex College
                                                                            (Nethermayne Campus)

TC0042 (Nethermayne)
South Ockendon, Ford Place
South Ockendon, South Road
(outside Thurrock Garden Centre)
South Ockendon, Police station
South Ockendon, Foyle Drive/
Darenth Lane
Aveley, High Street (Mill Road Ga-
rage)
Purfleet, Tank Hill Road
West Thurrock, London Road/
Southview Road
South Stifford, Moore Avenue
Grays Bus Station, Bay 1                              Passenger Transport Unit, Thurrock Council,
Grays, Hathaway Road
Grays, The Oaks PH                                                 Civic Offices, New Road, Grays,
Sth Essex College, Nethermayne                                                    Essex, RM17 6SL
Campus
                                                               T: (01375) 413882 F: (01375) 413891
                                                          E: PassengerTransport@thurrock.gov.uk
                                                         W: www.thurrock.gov.uk/travel/transport

								
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