PLEASE ENSURE ALL PAGES ARE COMPLETED AND SIGNED Year Term APPLICANT DETAILS RESIDENTIAL STREET ADDRESS Unit # Street # Address Town/Suburb State Postcode Exact distance (in km) by the shortest practicable route From home to school km From home to bus stop km PARENT/GUARDIAN DETAILS First Name Surname Telephone First Name Surname Telephone Email TRAVELLER DETAILS Student one First Name Surname Date of birth Travel start date School enrolled Year level FTE (must be 3 days or more VSN attendance): Student claiming (please use X to highlight) To/From School and off To/from school campus Single mode (One mode of transport Multi mode* only) Must be 4.8km or more to Bus Stop Student two First Name Surname Date of birth Travel start date School enrolled Year level FTE (must be 3 days or more VSN attendance): Student claiming (please use X to highlight) To/From School and off To/from school campus Single mode (One mode of transport Multi mode* only) Must be 4.8km or more to Bus Stop Student three First Name Surname Date of birth Travel start date School enrolled Year level FTE (must be 3 days or more VSN attendance): Student claiming (please use X to highlight) To/From School and off To/from school campus Single mode (One mode of transport Multi mode* Must be 4.8km or more to Bus Stop only) Note: An eligible student may be granted an allowance based on the least expensive public transport fares only. A copy of your ticket/fare purchase should be attached to this form e.g. Victorian Student Pass, Transit Student Pass. If there are more than three students claiming from this home residence, please complete another Form 3 and attach together. *Multi mode provision does not apply if the journey could have been undertaken using a single mode transport or one leg of the journey is less than 4.8km. If multi mode includes private travel, complete Form 1 (private car) or Form 2 (private bus) to accompany this public travel application.
Year Term PLEASE ENSURE ALL PAGES ARE COMPLETED AND SIGNED APPLICANT DETAILS RESIDENTIAL STREET ADDRESS Unit # Street # Address Town/Suburb State Postcode Exact distance (in km) by the shortest practicable route From home to school km From home to bus stop km PARENT/GUARDIAN DETAILS First Name Surname Telephone First Name Surname Telephone Email TRAVELLER DETAILS Student one First Name Surname Date of birth Travel start date School enrolled Year level VSN FTE (must be 3 days or more attendance): Student claiming (please use X to highlight) To/from school To/From School and off campus Single mode (One mode of transport only) Multi mode* Must be 4.8km or more to Bus Stop Student two First Name Surname Date of birth Travel start date School enrolled Year level VSN FTE (must be 3 days or more attendance): Student claiming (please use X to highlight) To/from school To/From School and off campus Single mode (One mode of transport only) Multi mode* Must be 4.8km or more to Bus Stop Student three First Name Surname Date of birth Travel start date School enrolled Year level VSN FTE (must be 3 days or more attendance): Student claiming (please use X to highlight) To/from school To/From School and off campus Single mode (One mode of transport only) Multi mode* Must be 4.8km or more to Bus Stop Note: An eligible student may be granted an allowance based on the least expensive public transport fares only. A copy of your ticket/fare purchase should be attached to this form e.g. Victorian Student Pass, Transit Student Pass. If there are more than three students claiming from this home residence, please complete another Form 3 and attach together. *Multi mode provision does not apply if the journey could have been undertaken using a single mode transport or one leg of the journey is less than 4.8km. If multi mode includes private travel, complete Form 1 (private car) or Form 2 (private bus) to accompany this public travel application.
Form-3-publictransporttravel.docx