Post 16 travel - new application

Academic Year 2009/2010

Please use this form only if you are making a first application for this academic year 2009/10.
This includes:

New students applying for a Post 16 pass for the first time
Students who had a travel pass for academic year 2008/09

Please use this form to apply and pay for your Post 16 travel pass.

Note: Those questions marked with an * must be completed.

Payment *

Payment

£45 - all students - termly pass (Summer)

Please note: You must provide payment after completing the form. After clicking the submit button below you will be taken to our secure online payment website. You can then make the required payment using either a credit or debit card. You will be charged a 1.9% surcharge if you pay using your credit card.

Student details

Title
If Other, please specify
First name(s) *
Surname *

Please enter your post code in the box below and then click on the "Lookup address" button. If your address is NOT SHOWN in the list or is incorrect, you will need to type your address in the boxes provided. In this case please supply as much information as possible.

Post code *Please input your post code using capitals and include a space between the first and second parts e.g. DN17 5TY.


Prefix e.g. first floor flat.
House name/number *
Street *
Town/Village *
County *

Please note: if you do not live in North Lincolnshire you should not complete this form. You should apply to the local authority where you live. If in doubt please ring School Transport for advice on 01724 297218.

Date of birth *

Date of birth

Email address *

Contact telephone no.

Previous School/College *

Chosen College/Sixth form *

If Other, please enter the name of the college here

Important: If you will be attending North Lindsey College. Before paying the full year fee, please consult North Lindsey College regarding the availability of financial assistance.

Title of course *

Length of course *

Are you living with your parent/guardian? *

Are you living with your parent/guardian?

Yes

When did you move to North Lincolnshire?

Photograph (passport type)

Note: All applications for this academic year must be accompanied by a passport sized photograph.

If you are unable to attach a digital passport type photograph of yourself please post one to North Lincolnshire Council, Education Transport, PO Box 35, Station Road, Brigg, DN20 8XJ. Please write the form reference number on the reverse of the photo.

Data Protection

The information provided on this form will be held on computer by North Lincolnshire Council, it may be issued to other organisations, e.g. transport providers, but will be used only for the purpose of student travel.

Declaration

I accept the travel pass issued to me is subject to the Policy & Conditions published by North Lincolnshire Council and the conditions of any bus or rail operator. Should I no longer require the pass I will return it immediately to the address on the reverse of the pass (By doing so you may be eligible for a refund).

Please tick the box below to indicate you have read and accept North Lincolnshire Council's Policy and Conditions for issuing post 16 travel passes.

Policy and Conditions *

I accept

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