Transportation Assistance Application

Transportation Assistance Application
Name*

First NameLast Name
Student ID*
Program of Study*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
County of Residence*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Clinical Location (If Applicable)
Clinical Dates (If Applicable)
I First Name* Last Name* understand that I am receiving (up to $100 per academic year) in transportation assistance. The gift cards issued are to be used to assist in my travel to and from VGCC for class attendance or clinicals. I understand that KARTS will be offered if I live within the VGCC service area and/or my clinicals are located within VGCC's service area.
In order to be considered, you must complete the following:

Complete the Student Emergency Application. Attach the completed Travel Assistance Application, along with recent gas receipts, to the document section of the Student Emergency Application. Receipts must have a current date (we will only accept receipts within a 3-week timeframe of the date the request is made). Gas cards are issued as a form of reimbursment, up to $100.

Your Travel Assistance Application will be available as a downloadable PDF upon submission. It will arrive via email. Please check your spam folder.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: