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Travel Assistance Training
Home
Travel Assistance Training
Application Form
Travel Assistance Training
Travel Trainee Name
Date of birth
Home Address
City
County
Post Code
Telephone
Gender
Male
Female
Other
Is this a referral from an external source?
Yes
No
Please state the journey the travel trainee needs to learn (include the day and the time)
Please comment on: Medical information: Include any allergies
Additional information
Sensory/physical disabilities
Behaviour
Phobias
Does this person currently receive transport support?
Yes
No
Please outline travel support need
Recognise the dangers of the road?
Yes
No
Use a light controlled and/or pedestrian crossing?
Yes
No
Cross streets safely, without using a recognised crossing?
Yes
No
Learn to remember routes and directions?
Yes
No
Read a bus number/destination?
Yes
No
Request help from an appropriate source?
Yes
No
Deal appropriately with strangers?
Yes
No
Maintain their own personal safety?
Yes
No
Additional information
Submit
