Application Form for Subsidised Routes
APPLICATION FOR BUS PASS ACADEMIC YEAR 2016-2017 YOUR DETAILS: Surname: First Name: Date of Birth: Age at 31/8/16: Address: Post Code: Contact No: Email Address: DETAILS OF TRAVEL (outward journey only) Please state precisely the BUS STOP you will use. (Please see time tables on reverse. Times overleaf are approximate and will be confirmed before the start of your course). Bus Route: COL04 please circle COL01 COL03 COL05 (see over) Nantwich/ SHUTTLE Holmes Maccles/ Chapel/ Crewe/ Winsford/Hartford Middlewich/ Knutsford Tarporley Sandbach Winsford Bus Stop: YOUR COURSE: Title of course: Duration of 1 year or 2 years course: Days in College if Mon Tue Wed Thurs Fri known (please circle) PLEASE READ AND SIGN HERE The College will provide a bus pass to Further Education Students on a full time course, subject to the availability of seats. The cost to be confirmed for 2016-17, but you will have the option to pay termly. Bus passes will be available for collection at enrolment or during the first weeks of each term. I declare that it is necessary for me to travel in accordance with the details given and that to the best of my knowledge and belief, these details are correct in every respect. I undertake to return the bus pass to the College, if I withdraw from my course before the end of the academic year, or otherwise become ineligible to receive assisted travel. Signed: Date:………………………………………………… Please return this form to: Student Services, Mid-Cheshire College, Hartford Campus, Northwich, Cheshire, CW8 1LJ. Tel: 01606 720 649 APPLICATION FOR
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