SEND Travel Application | Wiltshire Council

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SEND Travel Request Application

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Application for support with travel for children with Special Educational Needs (SEN)

(This application form applies for pupils of compulsory school age only – up to and including year 11)

If you are wishing to apply for support with travel in accordance with the SEND Transport Policy for your child please complete the form below.

In order that we can make an appropriate decision, please can you complete the form below. Once this information has been received and if agreed, the Passenger Transport Unit will be asked to make the travel arrangements and will be in contact with you when they are in place.

Please note that support with travel is only provided for those who meet the eligibility criteria outlined in the policy document. Please refer to Wiltshire Council Local Offer for additional information.

If you need help completing the form text or need any further information, please do not hesitate to contact me on 01225 757943 or via email to SEND.transport@wiltshire.gov.uk

Applicant Details

Child's first name : *

Child's middle name :

Child's last nane : *

Child's date of birth : (e.g. 01/01/1980) *

Parent or Guardian details

Parent or guardian first name : *

Parent or guardian last name : *

Parent or guardian address line 1 : *

Parent or guardian address line 2 :

Parent or guardian address line 3 :

Parent or guardian address line 4 :

Parent or guardian postcode : *

Parent or guardian work telephone number : *

Parent or guardian mobile number : *

Parent or guardian email address : *

Emergency contact details

If in an emergency, you are ever not at home or at the pick-up point to receive your child, is there a responsible adult other than yourself who lives near to your home who has previously agreed to look after your child? If so, please give details.

Emergency contact name : *

Emergency contact address line 1 : *

Emergency contact address line 2 :

Emergency contact address line 3 :

Emergency contact address line 4 :

Emergency contact postcode : *

Emergency contact telephone : *

School details

School for which transport is required : *

School postcode : *

School start date : *

Type of placement :

Special needs

Please tick any of the following that apply to your child and supply additional information if needed.

Emotional and behavioural difficulties :

Social and communication (ASD) :

Speech and language difficulties :

Moderate learning difficulties :

Hearing impairment :

Visual impairment :

Physical disabilities :

Severe learning difficulties :

If other, please give us details in the box below :

Special requirements

Does your child use a wheelchair ?

If YES, can they transfer out of their wheelchair into a vehicle seat ? (also with minimal assistance or with the assistance of a Patslide ?)

Please state the make and model of the wheelchair.

Wheel chair make :

Wheel chair model :

Please note if your child uses a wheelchair an on-site assessment will need to take place prior to transport commencing.

Can your child use a standard vehicle seat belt?

If NO, do you currently use a child safety seat for your child?

If YES, please state the type of child safety seat you use :

If a child safety seat is required, please state your child's height and weight.

Height : *

Weight : *

Child Safety Seat Assessment Required ?

Other important information

Please note that providing this information will not affect your child's entitlement but will help us to provide support suitable to his/her needs. Please provide as much information as you can.

Has your child any history of violence and/or aggression ?

If yes, please give details:

Is this behaviour triggered by anything in particular ?

If yes, please give details :

Are there significant concerns if your child were to travel with others?

If yes, please give details :

Is there a need for driver/vehicle introduction before travelling ?

Medical Information

Please tick if your son / daughter has any of the following :

Asthma :

Epilepsy :

Allergies :

Vomiting :

Travel Sickness :

Incontinence :

Please mention any other medical information in the box below :

Does your child have a medical flow chart or care plan ? *

If Yes a copy must be emailed to our team. We will give you instructions on how to do this after you have completed and submitted this form.

Please note the care plan you provide must be the most recent.

Please ensure that Passenger Transport are informed of any change in health needs.

If we are not advised of health need changes we reserve the right to suspend transport.

Additional medical information

In the box below, please can you provide additional information about your child’s medical condition e.g. frequency of seizures etc :

Is your child taking any regular medication? If so, is it required to be transported with them?

If yes, please give details in the box below :

How does your child communicate with others?

Spoken word :

Makaton :

PECS :

BSL :

Please mention any other communication methods in the box below :

Special requirements

Does your child use a harness or car safety seat when being transported privately by you?

If the answer to the above is Yes then what make and model of harness or safety seat is used?

Does your child ever refuse to wear or constantly attempt to remove their seat belt or their safety seat harness? Please note: This also includes wheelchair users.

Does your child have any difficulties that would prevent them from accessing a vehicle?

If the answer to the above is Yes, please give us details in the box below :

How do you transport your child at the moment and how do you manage this?

Is there any additional information that we need to be aware of whilst transporting your child?

Would you consider providing transport yourself with re-imbursement of petrol costs?

If your child is assessed as requiring a PA would you be prepared to be a Passenger Assistant (PA escort) for your child?

Please note there maybe occasions where you could be required to support this journey if the PA is not available.

Data protection

Data protection statement – Data Protection Act

Wiltshire Council has a duty to protect personal information; Wiltshire Council will process this information in accordance with the Data Protection Act 1998. This information will be stored on the computer and manual files. This personal data will be used only for the purpose of providing transport, or purposes relating to this service.

Please note we require a minimum of 3 weeks from receipt of your application to arrange suitable transport and potentially this could take longer due to the complex needs of some students. Failure to provide any relevant information about your child may cause further delays.

The local authority, with careful consideration, will decide what form of support with travel will be provided. The local authority prefers to use shared transport.

Submit your application