Conveyance Allowance application form Applicant detailsAddress(Required)Town / Suburb(Required)State(Required)Postcode(Required)Distance form home to school.Needs to be more than 4.8 km from school to be eligibleParent / Guardian detailsFirst name(Required)Surname(Required)PhoneEmail(Required)First nameSurnamePhoneEmailTraveler detailsStudent OneStudent first name(Required)Student Surname(Required)Date of Birth(Required) DD slash MM slash YYYY Travel start Date(Required) DD slash MM slash YYYY School Enrolled(Required)Year levelVSNFTE (must attend 3 days i.e. FTE 0.6 or more):Student claiming To/from school Off campus only To/from school and off campus Student TwoStudent first nameStudent SurnameDate of Birth DD slash MM slash YYYY Travel start Date DD slash MM slash YYYY School EnrolledYear levelVSNFTE (must attend 3 days i.e. FTE 0.6 or more):Student claiming To/from school Off campus only To/from school and off campus Student ThreeStudent first nameStudent SurnameDate of Birth DD slash MM slash YYYY Travel start Date DD slash MM slash YYYY School EnrolledYear levelVSNFTE (must attend 3 days i.e. FTE 0.6 or more):Student claiming To/from school Off campus only To/from school and off campus Eligibility An application on behalf of a student may be submitted if the student is: a Victorian resident. school aged and enrolled (3) three or more days per week at a school; and attends a specialist school or recognised special setting anywhere in Victoria A student who meets the above requirements may be eligible if they: reside within the Designated Transport Area (DTA) for the Government Specialist School attended and is on the Program for Students with Disabilities (PSD)/ Disability Inclusion Tier 3 student-level funding, or attend their nearest appropriate non-government specialist school, or attend their nearest recognised special setting, and reside 4.8km or more by the shortest practicable route from the school/campus attended Note: Eligibility is assessed when the School completes your child’s application on the Student Conveyance Allowance System (SCAS). If approved, the allowance payable is based on the one-way distance to make the journey to and from school. A student may be eligible for the conveyance allowance if a physical, behavioural or health reason prevents them from accessing the bus. The School must inform the Student Transport Unit whether a student is accessing a bus or a conveyance allowance claim to assist with management of bus loadings on services. Students who are privately transported 4.8km or more to meet public or school transport services may be able to claim a private car conveyance allowance as well (Multi mode). For further information regarding the Conveyance Allowance Program see: https://www2.education.vic.gov.au/pal/conveyanceallowance/ policy?Redirect=1 *Multi-mode conveyance allowances Multi-mode conveyance allowance applies when a student uses more than one mode of transport (e.g. private car and public transport) for a journey between home and school.Parent / Guardian to completeI certify that: All the above details are true and correct to my knowledge. I will notify the principal/delegate in writing within 7 days of any change of address or school. The school will use personal information I have provided such as my address, child’s enrolment details to assess and confirm their eligibility for the Conveyance Allowance Program using the Student Conveyance Allowance System (SCAS). I consent to release this information to Department of Education (DE) representatives to assist with assessing my application on SCAS. I understand the conveyance allowance is for the student/s named on the application form/s and cannot be withheld by the school in lieu of fees or late payments. I understand my signed consent is required with this application form for the school to keep the conveyance allowance as a contribution towards privately procured transport services to and from school only (if you agree to give consent, please complete/sign consent below). Parent / Guardian name(Required)Signature(Required)Date(Required) DD slash MM slash YYYY Parent / Guardian consent for school to withhold conveyance allowanceI consent that: The conveyance allowance payable to the student/s named on this application form will be withheld by the school as a contribution towards privately procured transport services to and from school only. I understand there may be additional costs incurred which the school may request that I cover. I understand the conveyance allowance cannot be withheld or contribute towards procured bus services for school excursions. I will notify the principal/delegate in writing if I wish to withdraw my consent to withhold my child’s conveyance payments. I understand withdrawal of my consent may not be effective until the next term claim period. Parent / Guardian nameSignature(Required)Date(Required) DD slash MM slash YYYY
