Home to School Transport Application Form

For Office Use only Date Rec. S139 incl. Y/N If N: emailed Date rec S139

Home to College Transport Application Form

Please use this form to apply for assistance with travel to and from college. This is for students who have special educational needs, disabilities or medical needs. If you require help with completing this form, please contact SEN Transport Section on 0208 708 8215 or by e-mailing [email protected]

Please note that first time applicants for college transport will require a form S139, which is an assessment form and is provided by Redbridge Connexions. Please contact Connexions on 0208 514 9567 to arrange for this form to be completed.

Please note: It can take up to4 weeks for an application to be processed

Section 1

Details of Student:

Forename: Surname:

Middle Known as (if Name: different from forename) : Male/Femal Date of Birth: e Current Age (in Address September; at start of college) Post Code: Current School:

**Student **Student Mobile No: email address: ** If you do not wish for the student to be contacted directly with transport updates, please leave blank.

Details of the college that you require transport too: Name: Address: Postcode: Course Studying: College Contact College Contact Name: Number: Date which you require transport to commence: …..…/……../……….

Section 2

Details of transport required

Please indicate days and times transport will be required:

DAY AM START TIME PM FINISH TIME

Please Indicate in the box below if the transport required is not daily (provide as much detail as possible)

Did the student have a Statement of Special Educational Needs whilst at school? Yes No

Did the student receive transport whilst attending school? Yes No

Section 3

Students’ Personal Details

Director of Children’s Services: Pat Reynolds 2 V1.0 Does the student need to travel in a Wheelchair ? Yes No (Wheelchair must be crash tested) If yes, please specify type… … … … … … … … … … … … … … … … … … … … … … …

Is the student able to walk short distances unaided? ie between home & vehicle Yes No

Is the student able to walk up & down vehicle steps? Yes No (if bus used)

Does the student have Yes No communication difficulties? If yes, how does your child communicate ie Makaton, signing, or Pecs etc, please specify … … … … … … … … … … … … … … … … … … … … … … … … … … … .

Does the student have any emotional and/or Yes No behaviour difficulties? If yes, please provide details: ………………………………………………………………………… …………………………………………………………………………

Does the student have physical or sensory Yes No difficulties? If yes, please provide details: …………………………………………………………………………. ………………………………………………………………………….

Does the student have any medical condition that may need intervention on transport? Yes No e.g. requires oxygen, allergies, asthma or epileptic medication If yes, please provide details, including possible frequency: …………………………………………………………………………… ……………………………………………………………………………

Director of Children’s Services: Pat Reynolds 3 V1.0 Additional Information

Please explain any details about the students Disability / Medical condition not previously mentioned.

Would the student be able to travel to college on public transport even if accompanied? Yes No

If you answered NO to the last question, Please give reasons why?

SEN & Inclusion section is currently running an Independent Travel Training Program. It is intended that learners should be able to leave the scheme with the ability to travel independently. Please tick the box if you are interested in this scheme

Section 4

Detail’s of Parent/Carer (please inform this office if any of the information changes, after submission)

Director of Children’s Services: Pat Reynolds 4 V1.0 Title:

ForeName: Surnam e: Address (if Post same as child Code: leave blank

Contact Details:

Mobile ** Email:

** A mobile number must be provided as transport updates are sent by text message.

Emergency Contact details:

Forename:

Surname:

Relationship to child: Contact number:

Please note any transport assistance provided is at the Special Educational Needs and Inclusion Services discretion and is annually reviewed.

Section 5

Director of Children’s Services: Pat Reynolds 5 V1.0 Declaration

I declare that to the best of my knowledge the information I have given is correct and complete. I will inform the Special Educational Needs & Inclusion Services if any details I have given change. I agree that if transport assistance is agreed, the information I have given may be shared with Redbridge Transport Services to provide my child with safe and appropriate transport.

Name …………………………..Signed…………………………..Date……………..

Data Protection Your personal information will be held and used in accordance with the requirements of the Data Protection Act 1998. We have a duty to protect the public funds we administer and may use the information you provide for the prevention and detection of fraud. We may also share this information with other bodies responsible for auditing or administering public funds for these purposes.

What to do now

Make sure you have completed all sections of the form to avoid any delays occurring and send to the following address:

SEN & Inclusion Services Transport Section Station Road Centre Barkingside IG6 1NB

Director of Children’s Services: Pat Reynolds 6 V1.0