Redbridge e-forms Application for sixth form travel award 1Child2Parent/Guardian details3Details of other parent/guardian4Parent/Guardian contact details5Details of dependant children6Income7Declaration To qualify for a School Sixth Form Travel Award, all of the following must apply: Pupils must live more than 3 miles from their school The pupil’s family gross income must not be in excess of £12,000 for the current financial year (except families in receipt of Income Support/Income Based Job Seekers Allowance or PensionCredit) As London buses are free for students under the age of 18, the Authority will only provide support to pupils where their journey to school requires the use of British Rail Trains or the London Underground Students will be expected to contribute a third of their EMA funding towards their travelling costs Child's details Pupil(Required) First name Last name Date of birth(Required) Month Day Year School(Required) Parent/Guardian details Any award granted will be paid by cheque to the person named below. Please ensure these details are correct. N.B. If you don’t have a bank account, then name someone you know who can cash the cheque for you. Parent/Guardian(Required) First name Last name I am the child's(Required) Mother Father Guardian Occupation Mother's detailsMother's first name Mother's last name Mother's occupation Father's detailsFather's first name Father's last name Father's occupation Parent/Guardian contact detailsAddress(Required)Find addressSelected address Daytime telephone numberEmail(Required) Details of dependant childrenGive below details of all dependant children (other than the student) including those of and under school ageFull nameDate of birthSchool(s)/college(s) to be attended (if any) in September Add Remove IncomePlease answer all questions by either stating the income or inserting '0'. Relevant documentary evidence of income must be submitted with this form.Father's gross income from employment and/or self employmentPlease enter a number greater than or equal to 0.Father's gross wages/salary from additional part time workPlease enter a number greater than or equal to 0.Mother's gross income from employment and/or self employmentPlease enter a number greater than or equal to 0.Mother's gross wages/salary from additional part time workPlease enter a number greater than or equal to 0.Guardian's gross income from employment and/or self employmentPlease enter a number greater than or equal to 0.Guardian's gross wages/salary from additional part time workPlease enter a number greater than or equal to 0.Child benefitPlease enter a number greater than or equal to 0.Income Support/Job Seekers Allowance (income based)Please enter a number greater than or equal to 0.Unemployment benefit/Job Seekers Allowance (contribution based)Please enter a number greater than or equal to 0.Working tax creditPlease enter a number greater than or equal to 0.Child's tax creditPlease enter a number greater than or equal to 0.Incapacity benefitPlease enter a number greater than or equal to 0.Widowed mother's allowance or widows pensionPlease enter a number greater than or equal to 0.Retirement Pension (State Pension)Please enter a number greater than or equal to 0.Employer(s) Superannuation or Retirement Pension (State Pension)Please enter a number greater than or equal to 0.Disability Pension/BenefitPlease enter a number greater than or equal to 0.Separation allowance/maintenance/child supportPlease enter a number greater than or equal to 0.Income derived from property or land and/or sub-lettingPlease enter a number greater than or equal to 0.Interest from investments including bank and building society interestPlease enter a number greater than or equal to 0.Other incomePlease enter a number greater than or equal to 0.TotalPlease give details of the source of any other income Please upload all documentary evidence required Drop files here or Select files Max. file size: 50 MB. This Authority is under a duty to protect the public funds it administers and to this end may use this information you have provided on this form within this Authority for the prevention and detection of fraud. It may also share this information with other bodies administering public funds solely for these purposes. The Children’s Services department of the London Borough of Redbridge is registered under the Data Protection Act 1998. If you knowingly provide misleading or false information you may be liable to prosecution. Details of family benefits from all sources should be dated within the last six weeks or current financial year where indicated. Declaration I declare that all information given on this form is to the best of my knowledge correct in every respect and I UNDERTAKE to inform the Children’s Services department of any changes in the particulars given concerning my circumstances. If for any reason, the pupil named on this form either leaves School or fails to complete the course for which he/she has been granted an award, or ceases to reside in the Redbridge area, I undertake (a) to notify the Director of Children’s Services immediately and (b) to return the award upon request.Signed(Required)Typing your name in this box is assumed as your electronic signature