Get documents about "app_transport_over16
Document Sample
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
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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
