Dot Student Registration Form 2016: Student Subsidised Travel Scheme
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1Student registration form 2016
Student Subsidised Travel Scheme
Please complete this form to register your child for the Student Subsidised Travel Scheme (SSTS) for the 2016 school year.
This form must be accompanied by at least one Travel Application Form (SSTS2).
Parent 1: The person who has (or shares) primary care for the student and will be the primary contact.
Given name/s _________________________________________ Family name _____________________________________
/
/
Relationship to student ________________________________________________ Date of birth ____
____
__________
Married
Divorced
Separated
Never married
Widowed
Living in a de facto relationship
Postal address: ___________________________________________________________________ Postcode _____________
Residential address: (or as above) ____________________________________________________ Postcode _____________
Preferred phone # ____________________________
Email address _____________________________________________
Do you have primary care and sole/shared custody for the student?
YES
NO
If you answered NO, please supply a statement describing why the primary care giver cannot apply.
Are you a permanent resident of Western Australia?
YES
NO
If you answered NO, you are not eligible for the SSTS
If you answered YES, please supply a copy of a letter or card issued by a Government department showing your name and residential address
Parent 2: Other parent (details of BOTH parents must be provided to establish eligibility)
Given name/s _________________________________________ Family name _____________________________________
/
/
Relationship to student ________________________________________________ Date of birth ____
____
__________
Postal address: (or same as parent 1) __________________________________________________ Postcode ____________
Residential address: (or as above) _____________________________________________________ Postcode ____________
Preferred phone # ______________________________
Email address ___________________________________________
Whereabouts are unknown
Student:
Given name/s _______________________________________ Family name ____________________________________
/
/
Date of birth ____
____
_________
Gender:
Male
Female
Year level/grade for 2016 ___________
School being attended _____________________________________ Is the student boarding at this school?
YES
NO
If NO, where does the student live during term/semester? _______________________________________________________
Does the student receive any payments from Centrelink?
YES
NO
If you answered YES, you are not eligible for the SSTS
Is the student an Australian citizen or permanent resident?
YES
NO
If you answered NO, you are not eligible for the SSTS.
Please provide a copy of the permanent residency visa if applicable.
Have you claimed the SSTS for this student in previous years?
YES
NO
Declaration:
I declare that the information provided on this application is complete and true and I authorise the Department of Transport to
confirm these details if required.
/
/
Signature of parent 1: ______________________________________ Date signed: ____
____
__________
Submission: Please send this form along with a Travel Application Form (SSTS2) to Travel Subsidies, GPO Box C102, Perth
6839 via the school for endorsement. Need assistance? Please free call 1300 660 147 or email
travelsubsidies@transport.wa.gov.au
SSTS1
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