1Page 1 2Page 2 3Page 3 4Page 4 5Summary Progress Child/young person details First name Last name Date of birth Day Month Year Address Postcode Find Address Loading addresses... Select Address -- Please select -- Address line 1 Address line 2 (optional) City Postcode Clear postcode/address Use the Lookup Postcode button to find the address.If you cannot find the address, please enter it manually School Year group Nursery and Reception Years 1-6 Years 7-11 Years 12-14 Specify year group Following a travel support assessment, if transport is deemed as the only suitable option, a financial contribution is payable. Payment can be made by instalments from October to June. The fixed learner contribution will be reduced by 50% for students who would have qualified for free school meals, or whose parent/carer are on low-income and can provide evidence of a means tested benefit. Families are encouraged to contact the school/college directly and request assistant from them in relation to the 16-19 bursary fund. Do you wish to apply for the 50% reduction in the fixed contribution costs? Yes No Parent/Carer Date of birth Day Month Year Parent/Carer National Insurance number Do they have an Education, Health and Care Plan? Yes No Is the school named in the Education, Health and Care Plan? Yes No Is the school named in the Education, Health and Care Plan their local school? Yes No Is this a school the local authority has chosen to meet your child's needs? Yes No Is this a school of your own choice? Yes No Is the child looked after? Yes No Looked after by which Local Authority? Is the young person a young carer? Yes No Provide evidence from support worker or association involved No information is required, please proceed to the next page. Parent/Carer details First name Last name Relationship to pupil Parent Carer Other If other please state Email address Telephone number No information is required, please proceed to the next page. How the child/young person currently travels to school Tell us all the options the child/young person uses Parent/carers car Walks Cycles By Public bus Council transport Someone else's car Not yet attending school Other If Other please state Tell us all the options the child/young person uses for non school travel. Have they ever: Walked to a destination alone - to local shops/friend’s house? Travelled independently via public transport? Used public transport at weekends or out of school hours? Never travelled independently Other Please give details of where they travelled to and how often Do you or another family member have access to a car? Yes No If you are willing to transport your child to and from school, there is a daily mileage allowance for two return journeys per day subject to attendance at school, which must be above 80%. Is this a mobility vehicle provided for the child or young person? Yes No Would you wish to receive a personal transport budget which pays for the car mileage to help you get your child to and from school? We pay 0.45 per mile for two return journeys, plus a fixed fee of £3.00 per day. Yes No Will they be travelling in a wheelchair or have any mobility aides? Yes No Please give details of the wheelchair and mobility aides? Please check with the wheelchair manufacturer that it can be used in a vehicle. If not we may be unable to offer any transport. Do you or your partner have a disability which you feel prevents you from helping you get your child to school? Yes No Please specify details of you or your partner’s disability Please attach medical evidence confirming the details of your disability and how it impacts the assistance you can give your child. To upload multiple files, hold 'Ctrl' (Windows) or 'Cmd' (Mac) when choosing files to upload. Are you, or another appropriate person, available to travel with your child to school in a morning and/or afternoon? Yes No Do you have any other children? Yes No Please list all the other children living at the same address First name Last name: Age School Year Group School start time School finish time Add child Will your child travel to and from an address other than the home address? Yes No Please give details. Not all requests for alternative pick-up and drop-off destinations can be met. Transport to an alternative address will only be considered if you can provide evidence of shared parental responsibility. Transport is required for This academic year Next academic year Please add any further information you think will support your application (optional) No information is required, please proceed to the next page. Parent/carer declaration I declare that the information provided in this form is correct at the time of submission. If any of the circumstances change I agree to notify sen.transport@liverpool.gov.uk immediately.Should the council agree a form of travel assistance for my child I understand that:The council will review my initial application within 5 working days. If a further assessment or additional evidence is needed this may take an additional 15 working days. Where medical evidence is required the assessment process may take longer.It may be stopped if any information on this form is found to be incorrect.It will be reviewed at least once a year.Any change of circumstances for example a change of address may affect my child's entitlement to travel assistance will result in a review of the type travel assistance awarded.It may be withdrawn if the behaviour of my child presents a health and safety risk to themselves or others while travelling on the transport.The council may request additional information from other professionals, for example consultants or social care professionals, in order to make a decision on eligibility.My child needs to be ready at the agreed pick up point at the agreed time each morning.I am responsible for ensuring an appropriate person meets my child off transport, if awarded, unless I inform the council in writing.I understand that a fixed contribution is required for transport to post -16 education, If required, I agree for the council to check if I meet the low-income criteria, to qualify for the fixed contribution reduction of 50%. Declaration confirmation I have read and agree to the above parent/carer declaration I have read the privacy statement which states we use, share and store any personal data included in this form. Privacy statement confirmation I have read and agree to the above privacy statement No information is required, please proceed to the next page. Before you submit this form please review your answers below. If you need to change anything, use the 'previous' button on the bottom left to go back to a section. Then submit the form by selecting the 'Submit button' at the bottom of this page Loading form summary...