All fields with * are mandatory, and should be completed in full.
Name
Contact Number
Email Address
Confirm Email Address
Pupil Name
Date Of Birth
Which school do you require transport to? --Please Select-- Ashton CS College, Aldwych Drive, Preston PR2 1SL Atherton High, Hamilton Street, Atherton M46 0AY Bankview High, 177 Long Lane, Liverpool L9 6AD Birtenshaw, Darwen Road, Bolton BL7 9AB Bolton Impact Trust, Smith hills Dean Road, Bolton BL1 6JT Bridgeway School, Church Road, Preston PR5 6EP Byrchall High, Warrington Road, Ashton-in-Makerfield WN4 9PQ Cambian Tyldesley, Shuttle Street, Tyldesley M29 8BS Cansfield High, Old Road, Ashton-in-Makerfield WN4 9TP Cewe School, St Catherines Vicarage, Catherine Terrace, WN1 3JW Chatsworth Futures, Vicarage Road M27 0WA Chatsworth High, Chatsworth Road, Eccles M30 9DY Deanery High, Frog Lane, Wigan WN1 1HQ Ed Start Salford, 5 Gerald Road, Salford M6 6DW Egerton High, Kingsway Park, Manchester M41 7FZ Ellesmere Park High, 1 Wentworth Road, Eccles M30 9BP Elm Tree Primary, Elmers Wood Road, Skelmersdale WN8 6SA Expanse LSV, Sale Way, Leigh WN7 4JY Expanse Orrell, Lodge Orrell Road, Wigan WN5 8HJ Expanse, Tyrer Ave Tyrer Avenue, Wigan WN3 5XF Finch Wood Academy, Baileys Lane, Halewood L26 0TY Firwood High, Stitch-Mi-Lane, Bolton BL2 4HU Golborne High, Lowton Road, Golborne WA3 3EL Hawkley Hall, High Carr Lane, Wigan WN3 5NY Haydock High, Clipsley Lane, Haydock WA11 0JG Hope School, Kelvin Grove, Winstanley WN3 6SP Kingsbury Primary, School Lane, Skelmersdale WN8 8EH Landgate, Landgate Lane, Bryn WN4 0EP Lever Park, Stocks Park Drive, Bolton BL6 6DE Meadow Bank Primary, Formby Avenue, Atherton M46 0HX Newbridge High School, Moss Lane, Platt Bridge WN2 3TL Oakfield, Long Lane, Hindley WN2 4XA Other Penkford School, Wharf Road, Newton WA12 9XZ Pontville, Black Moss Lane, Ormskirk L39 4TW Priestly College, Loushers Lane, Warrington WA4 6RD Progress School Tyldesley, Lancaster Avenue M29 8LN Project Ink Bolton, Deane Road, Bolton BL3 5BG Project Ink Salford, A6 Crescent, Salford M5 4WU Rowan Tree Primary, Greenhall Close, Atherton M46 9HP Rumworth, Armadale Road, Bolton BL3 4TP Seashell Trust, Stanley Road, Cheadle Hulme SK8 6RQ Springwood, Graig Hall Site, Preston Avenue M44 5XB St Edmund Arrowsmith High, Rookery Avenue, Ashton-in-Makerfield WN4 9PF St Peter's High, Howards Lane, Orrell WN5 8NU The Aurora Brambles, Longmeanygate, Preston PR26 7TB The Holden School, 78 Chapel Street, Leigh WN7 2PQ The Holden School, Firs Lane, Leigh WN7 4SB Thomasson Memorial, Devonshire Road, Poynton BL1 4PG Wargrave House, 449 Wargrave Rd, Newton WA12 8RS West Lancs College, College Way, Skelmersdale WN8 6DX West Lancs High, School Lane, Skelmersdale WN8 8EH Westleigh High School, Westleigh Lane, Leigh WN7 5NL Westmorland, Weldbank Lane, Chorley PR7 3NQ Willow Grove Primary, Willow Grove, Ashton -in -Makerfield WN4 8XF
Name and postcode of school to which travel assistance is required
Is this the school that is named in your child's EHCP? Yes No
Is this your nearest school? Yes No
Was this school chosen by the Local Authority to meet your child's needs? Yes No
Year Group Please select Reception Y1 Y2 Y3 Y4 Y5 Y6 Y7 Y8 Y9 Y10 Y11 Y12 and over
Please use the application form for post 16 education.
Current School (if different from above)
Postcode / Street Name Search
I would like to enter my address manually.
Does your child live at more that one address during the school week? Yes No
Under the terms of our Home to School Transport Policy, transport will only be provided from one address. If familes are unable to determine which address will be used for transport, the residence used for child benefit will the one that is used for transport. Please tick to say that you understand.
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Is the child a looked after child? Yes No
Which Authority has financial responsibility?
Does your child have an EHCP or proof of diagnosis? Yes No
Details of need - Cognition and Learning (Specific Learning Difficulty; Moderate Learning Difficulty; Severe Learning Difficulty; Profound and Multiple Learning Difficulty 0 of 500 characters
Details of need - Communication and Interaction (Speech, Language and Communication Needs; Autistic Spectrum Condition) 0 of 500 characters
Details of need - Social, Emotional and Methal Health (SEMH) 0 of 500 characters
Details of need - Sensory / Physical (Hearing Impairment; Visual Impairment; Multisensory Impairment; Physical Difficulty) 0 of 500 characters
Does your child have a short term need e.g. a broken leg? Yes No
Details of need 0 of 500 characters
Can your child board a vehicle without support? Yes No
Please provide details of the support required 0 of 500 characters
Does your child have a mobility impairment? Yes No
Please specify 0 of 500 characters
Is your child a wheelchair user? Yes No
Please give the type of wheelchair
Does your child have any medical conditions? Yes No
What medical conditions do they have - please state all 0 of 500 characters
Does your child require the use of any rescue medications (midazolam, epipen etc)? Yes No
What medication do they require? 0 of 500 characters
Does your child's SEND make traveling difficult for them and are they affected by noise (music, talking etc) Yes No
How do they usually react, what do they do? 0 of 200 characters
Does your child's SEND make traveling difficult for them and are they affected by delays (traffic lights, traffic jams, breakdown etc) Yes No
Does your child's SEND make traveling difficult for them and are they affected by other passengers (proximity, talking) Yes No
Does your child's SEND make traveling difficult for them and are they affected by changes (staff, driver, vehicle etc) Yes No
Does your child have a Social Worker? Yes No
Social Worker name
Social Worker contact details
Do you consent to the Integrated Transport Unit (ITU) contacting the above for more information?
Does your child have a Community Nurse? Yes No
Community Nurse name?
Community Nurse contact details?
Any other Health and Social Care involvement (SALT, Physio etc)? Yes No
Other Health and Social Care name
Other Health and Social Care contact details
Does your child display issues with Travel Sickness? Yes No
How is your child best supported to manage this? 0 of 250 characters
Does your child have Continence issues? Yes No
Does your child display issues with throwing objects? Yes No
Does your child display issues with hitting and kicking out? Yes No
Does your child display issues with pulling hair? Yes No
Does your child display issues with scratching? Yes No
Does your child display issues with spitting? Yes No
Does your child display issues with shouting or crying? Yes No
Does your child display issues with banging their head? Yes No
Does your child display issues with unfastening their seatbelt? Yes No
Does your child display issues with running away? Yes No
Does your child display issues with anything else whilst travelling? Yes No
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Would you like a Personal Travel Budget to arrange your own travel arrangements? Yes No
Are either yourself or your partner disabled such that you are unable to accompany your child to school? Yes No
Please give the nature of the disability 0 of 500 characters
You will be asked to provide evidence from a medical practitioner such as a diagnosis letter or confirmation from GP/ Consultant.
Are either yourself or another appropriate adult available to take your child to school? Yes No
Please state what the barriers are? (note that it is reasonable to expect parents to do what is practicable to take their own child to school and being in work does not, on its own, mean eligibility for organised transport) 0 of 500 characters
Does your child travel to any destination independently? (out of school club/ local shop/ friends house)? Yes No
Please give details 0 of 500 characters
Would your child be interested in cycling to school? Yes No
Would you be interested in having a bus pass to travel independently? Yes No
Has your child travelled on public transport? Yes on their own Yes with support No
Does the family have a car? No Yes one Yes more than one
The Council may be able to reimburse you for taking your child to school in your own vehicle, what would be the barriers to you doing this? 0 of 500 characters
Is this car a mobility vehicle that has been provided for your child/ young person? Yes No
Are you currently in receipt of DLA or PIP for your child? No Yes lower rate Yes higher rate
Do you have any other children living at the same address? Yes No
Add New Child
Please give any other information you think is relevant to your application 0 of 500 characters
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