Children and Young People’s Service

POST 19SEND TRANSPORT ANNUAL APPLICATION FORM
Academic Year 2017/18
Student details
Title / DOB / Age
First Name(s) / Surname
House Name
or Number / Street
Town
County / Post Code

Renewal for Post 19 Transport: YES / NO

Course Details
School / College /Learning Providerattended during 2016/17
School / College / Learning Provider to be attended in 2017/18(if different to above)
Name of course you are planning to attend
and the campus/site / Duration (e.g. 1 Year)
Please give details of the days and times you will attend the course
Additional Details

Does the young person have an Education Health and Care Plan? Yes No

or a statement? Yes No
You do not need to provide proof but please tick the relevant box
Does the young person use a wheelchair? / Yes No
If yes, please give make and model:
Can the young person transfer to a seat in a vehicle?
Does the young person have any medical needs?
Please give details and attach a copy of their Health Care Plan if relevant
Does the young person or parent/carer have a car?
Does the young person have a social worker/assessor/co-ordinator?
If yes please give name/contact details: /
Yes No

Yes No

Yes No
Yes No
Are there any other circumstances we need to be aware of in relation to this application?
(e.g. behavioural issues)

Parent / Guardian Details

Title / Full Name
E mail Address
Telephone Number / Mobile Number
Full address and post code if different to the student
Parent and Student / Guardian Agreement
We understand and agree that: /
  • The information we have given is true and correct.
  • Transport will be by the most cost effective service available to the Authority and will be from the beginning and end of the normal school/college day. If the course timetable varies on particular days no alternative transport will be arranged.
  • If there is no transport directly from my address, I will have to make my own way to the nearest pick up point.
  • Transport will only be provided to the main school or college. Assistance will not be provided for work placement or periods of study away from the main campus.
  • Transport assistance is free of charge for eligible pupils. Details of eligibility can be found at
  • A parental allowance will normally be paid where there is no existing transport running.
  • The County Council can withdraw transport in certain circumstances (e.g. where a service is no longer running or a cheaper alternative is found).
  • Transport applications must be made on an annual basis.
De
Data Protection Act 1998 - The data collected on this form will be held on file for six years. North Yorkshire County Council may make enquiries about the validity of the information provided from other central and / or local government bodies, as deemed appropriate by the Authority. The County Council has a duty to protect public funds it administers and to this end may use the information provided 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.
Signatures (both student & parent/guardian must sign)
We confirm that we have read the above agreement including theTerms and Conditions and agree to abide by the conditions.
Student Signature / Date
Parent / Guardian- please complete section below and print clearly
Title / First Name(s) / Surname
Parent / Guardian Signature / Date
Send completed form to: SEN Business SupportTeam, County Hall, Racecourse Lane, Northallerton, DL7 8AE. Or email
It would assist us if your form was returned before 7July 2017. Please note that we cannot guarantee that transport will be set up in time for the new academic year if it is received after that date or if the full course details are not included (e.g. specific course name/days and times of attendance).