Travel Assistance Request Application Form

This form is to request travel assistance to a school, college or social care setting for a pupil who has SEND (Special Educational Needs or Disability) or for someone who is currently waiting for an assessment or diagnosis.
I confirm the pupil I am requesting travel assistance for has SEND or is currently waiting for an assessment or diagnosis.
Yes
Is this application for:
This academic year (now)Next academic year (September 2023)
Name

First name

Last name
Known as
Date of birth
Gender
MaleFemale
Is the pupil waiting for an assessment or diagnosis, do they have an Education and Healthcare (EHC) plan or statement?
YesNoCurrently being assessed
If you answered the above as yes or if they are currently being assessed, what are the details of the pupil’s needs and/or condition?
How does the pupil currently travel to school/other establishment?
Public transportCarOtherNot currently attending school
If you have selected 'Other' please explain how you currently travel:
Why are these arrangements no longer suitable or please provide details of why you require travel assistance?
Do you have a car?
YesNo
Can you use your car to take your son/daughter to and from school and the Council will pay you a mileage allowance?
YesNo
If you answered 'No' to the above question, please state why you cannot use your car:
Can the pupil respond to spoken instructions?
YesNo
Does the pupil have any behaviour patterns which may impact on others, e.g. punching, kicking or pulling hair?
YesNo
If yes, please provide details and any advice for when this behaviour occurs.
Does the pupil have a condition such as travel sickness, where the use of spillage wipes may be needed?
YesNo
Please include recent professional evidence to support your application. This can be from a Social Worker or Medical Professional.

*Please note there is an file size limit of 15mb for attachments. Attachments exceeding this size will result in unsuccessful form submission.
*Please note there is an file size limit of 15mb for attachments. Attachments exceeding this size will result in unsuccessful form submission.
If you do not have electronic versions of your document(s) please send them to: Trafford Travel Coordination Unit, Trafford Council, 2nd Floor, Sale Waterside, Sale, Manchester, M33 7ZF
Please indicate below if you have attached professional evidence
YesNo
Does the pupil use the following:
WheelchairBuggyMobility aid eg crutches or tri-walkerNone of these
Make and model of the wheelchair or buggy
Is the wheelchair or buggy in good condition?
YesNoNot applicable
Has the wheelchair or buggy been crash-tested?
YesNoNot applicable
Please tell us about any other aid that is used e.g. folding wheelchair
Can the pupil board a vehicle via a normal step?
YesNo
Does the pupil need a vehicle lift?
YesNo
Does the pupil require any of the following?
Car seatBooster seatHarnessNone of these
If you have selected harness above, do you consent to us using it where required?
YesNo
Do we have your permission for the pupil to sit in the front seat of the vehicle?
YesNo

Section 2
The journeys
Home address where the pupil will be collected and dropped off:

Address Line 1

Address Line 2

City

County

Postcode

Country
Is this a flat?
YesNo
Can vehicles easily reach this property?
YesNo
Please provide details of any obstructions
Where an alternative address is requested the decision rests with the Council whether to accept the request. A maximum of 1 other address will be considered and this should be no further in distance than the pupil’s main address. If there is an additional collection or drop off address, please contact the Travel Co-Ordination Unit on 0161 912 5055.
Which school is the pupil going to?
School name
Address line 1
Town
Postcode
Contact name
Contact phone number
Does the pupil attend school full time?
YesNo
If the pupil does not attend school full time, please indicate the times they will need transport
Monday morningMonday afternoonTuesday morningTuesday afternoonWednesday morningWednesday afternoonThursday morningThursday afternoonFriday morningFriday afternoon

Section 3
Your details
Name

First name

Last name
Relationship to pupil
Home phone number
Mobile phone number
Date of birth
National Insurance number
Email
If you wish to declare hardship, the Council will undertake a hardship eligibility check. If, you want to be considered for hardship please indicate below.
YesNo
Please note that if eligible for travel assistance, this is provided free of charge for pupils of statutory school age (5-16). If the passenger is of pre-school age (2-4) there will be a charge of £200 per term. Those who can demonstrate hardship will be charged £100 per term.
Please provide any further information to support your application

Section 4
Emergency contact details
Please provide contact details in case we are unable to contact you.
Emergency contact name

First name

Last name
Relationship to pupil
Emergency contact home phone number
Emergency contact mobile number
Emergency contact email address

Section 5
Declaration (by entering my name and the date below I confirm that this electronic signature is equivalent to my written signature.)
Name
Date

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Trafford Council, Trafford Town Hall, Talbot Road, Stretford, M32 0TH