Herefordshire Council - Application form for transport assistance for 16-19 year olds

Age

How old will you be on 1 September this year?*

16 - 18 19+

If you are over 19, then you are not entitled to transport support from Herefordshire Council. Please contact the college of your choice who may assist with the funding of your transport costs.

Council Tax

Does your household pay council tax to Herefordshire Council?*

Yes No

Which county does your household pay Council Tax to?*

Academic year

Are you applying for transport for now or for next September? Please choose the appropriate academic year from the drop down list below.

Parent/carer details

First name:*

Last name:*

Email:*

Daytime telephone number:*

Mobile telephone number (this may be used for SMS alerts relating to your childs school transport):

Parent/carer address

Enter your address and choose the correct entry from the list:*

Time at address

Time at your current address:

12 months or more Under 12 months

Student details

First name:*

Last name:*

Date of birth (dd/mm/yyyy):*

Gender:*

Female Male

Photo uploader - student photo

Browse Upload your childs photo*

Please note: maximum file size 5mb

Sibling details

Sibling travelling:

No Yes

Transport application

Please indicate which route you are requesting, if known: Please note a seat is not guaranteed until you receive your pass. If the bus route you have requested is full, you will be offered the next nearest service with space.

Please provide name and address of the school:*

Date that transport is required to start* (dd/mm/yyyy):*

Is this the 1st, 2nd or 3rd year of study?*

1st 2nd 3rd

Subjects you are studying:*

Do you intend to apply to your college for a bursary to fund your transport costs?*

Yes No

Additional information:

Direct debit details

If your application is successful and you would like to pay by direct debit, please provide the following information. In the event that you are not successful in obtaining a seat, your account details will be erased, and no direct debit will be set up.

Can you confirm you that you hold a UK bank/building society account and that you are the account holder?*

Yes

Can you confirm that you are the only person required to authorise debits from this account?*

Yes

Are the direct debit account holder details the same as the Parent/Carer details entered above?*

Yes

Name of account holder:*

Contact telephone number of account holder:*

Account holder address line 1:*

Account holder address line 2:

Account holder address town:*

Account holder address postcode:*

Email address of account holder:*

Bank/building society account number:*

Branch sort code (XX-XX-XX):*

Building society reference number:

Please note the following:

Confirmation of the Direct Debit set up will be sent within 3 working days before the first collection and the method of notification, post or electronically.

Herefordshire Council will appear against the Direct Debit payment on your bank account.

For any queries, please email transport.support@herefordshire.gov.uk

Direct debit guarantee

This guarantee is offered by all banks and building societies that accept instructions to pay direct debits.
If there are any changes to the date, amount or frequency of your Direct Debit, Herefordshire Council will always give you 3 working days’ notice in advance of your account being debited.
If an error is made in the payment of your direct debit, by Herefordshire Council or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society.

If you receive a refund you are not entitled to, you must pay it back when Herefordshire Council asks you to.

You can cancel a direct debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.

Application form for transport assistance for 16-19 year olds

Thank you for submitting your application.

We shall respond to your application within 28 working days. If you have provided an email address we will email you with the outcome of your application, if no email address has been provided a letter will be sent to you in the post. Your application reference number is .

Please visit our website for School Transport information and policies.

Return to the form again here.

Application form for transport assistance for 16-19 year olds

Unfortunately there was a problem processing your application.

Return to the form again here.