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Public TransportOther Conveyance Allowance Application

By Justin Diaz,2014-06-09 21:26
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Public TransportOther Conveyance Allowance Application

    Private Bus Travel Student Conveyance Allowance Application

    Students Attending a Primary or Secondary School 2012

1. Complete the form to the best of your knowledge excluding sections F and G

    2. To be eligible for conveyance allowance:

    ; Must be school age (between 5-18 years old)

    ; Must attend an eligible school within the conveyance area

    ; Must live 4.8km or more from the school by the shortest practical route

    ; Must attend the closest same type school as designated by Victoria Registrations and Qualification Authority (VRQA) 3. A private car or private bus conveyance allowance is not available if the journey could have been made using a

    Department-funded school bus or public transport service.

    4. Reimbursement is calculated on the basis of the one-way distance travelled.

    5. Distance is measured by the shortest practicable route between the student’s place of residence and their school. 6. The residential address should be based on the Rural Road Numbering System. Mailbox and PO Box addresses cannot be

    used. You can use Bing Maps as a reference: http://www.bing.com/maps/

    A copy of the conveyance allowance guidelines are available from the

    http://www.education.vic.gov.au/management/schooloperations/studenttransport.htm

    Student Claiming definitions:

    * To school allowance only attends school; > Off campus only travels to TAFE or Registered Training Organisation (RTO); ^ To school and off campus attends school and travels to TAFE or RTO

A SCHOOL FOR WHICH CONVEYANCE ALLOWANCE IS TO APPLY (one student per form)

    School Name: Campus:

B STUDENT DETAILS (Please print clearly)

    (If known) (If known) Student ID: Student VSN:

     First Name: Surname:

    (If known) Birthdate: FTE (time fraction):

     Enrolment Date: Exit Date:

     Contact Number: Year Level:

     Address :

     Suburb: Postcode:

    C STUDENT ENROLMENT DETAILS (Please circle or print clearly)

    Full fee students are not eligible Yes No International full fee paying?

    Defined as physically or intellectually disabled, blind or deaf Is the child severely disabled? Yes No

    Program for Students with Disabilities Yes No Is the student on the PSD Program?

    Student attending which Provider? School Special setting

    Must be more than 4.8km by shortest practical route (km’s) Distance from home to campus:

    Is student attending nearest campus? Yes No

D TRAVEL INFORMATION

    Student claiming: To school allowance* Off campus only> To school and off campus^

     Travel start date: Travel end date:

    Distance of shortest practicable route from the bus stop or pick up point nearest the student’s

    residence to school for which conveyance allowance is to apply. This may not be the actual (Km’s) distance travelled in the bus

    Private Bus Operator (school Km travelled Journey start home, street Journey end school, transit owned, charted, other): (one way) name, station, etc: location etc:

    Page 1 of 2

E PARENT/GUARDIAN DETAILS (Please circle or print clearly)

     First Name: Surname:

    Parent Guardian Contact Number: Applicant Type:

    Address :

     Suburb : Postcode:

F SPECIAL FACTORS

    (TO BE COMPLETED BY THE SCHOOL)

G SUBSEQUENT YEARS

    Subsequent years initial and date if no change to information (TO BE COMPLETED BY THE SCHOOL)

    H ELIGIBILITY FOR ALLOWANCE DECLARATION ; I declare that the information provided is true and correct

    ; The school attended is the nearest appropriate school or next nearest government school ; I will notify the school in writing within seven days of any changed circumstances Parent/Guardian Signature: Date: Principal Signature: Date:

    Application for Conveyance Allowances are subject to audit

    I SCHEDULE OF RATES: (Note: these are the maximum rates claimable per annum) Distance Kms 4.810 >1015 >1520 >2025 >2530 >3035 >35

    Private Bus $493.80 $604.20 $713.40 $823.60 $933.00 $1043.20 $1153.60

    Page 2 of 2

    DEECD collects personal information for the purposes of assessing eligibility for receipt of a conveyance allowance. Personal information will not be used for any other purposes and will not be disclosed to any other organisation/body. The department protects paper records in secure storage and computerised records are protected through access and authorisation controls. DEECD takes all reasonable technical and organisational precautions to prevent the loss, misuse or alteration of collected personal information. You are able to request access to the personal information that we hold about you and to request that it be corrected. Please contact your school directly. The Department respects individuals’ privacy.

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