Transportation Pass Request - Berkeley Public Schools Fund

Name of person submitting the form*

Form should be submitted by OFEE staff person, or equivalent in schools that do not have an OFEE staff person.

First Last

Email address of person submitting form*

Number of 31-day Youth passes needed*

Specify the number of 31-day AC Transit Youth passes needed.

Number of 31-day Adult passes needed*

Specify the number of 31-day AC Transit Adult passes needed.

Number of 1-ride Youth passes needed*

Specify the number of 1-ride AC Transit Youth passes needed.

Number of 1-ride Adult passes needed*

Specify the number of 1-ride AC Transit Adult passes needed.

School(s) of student(s)

Which school(s) do the student(s) attend?

Description*

Describe reason for needing transportation passes.

Who will pick up the pass(es)?*

Passes can be picked up in North Oakland by either requestor or recipient family.

Recipient to pick up in North Oakland
Requestor (you) to pick up in North Oakland

Recipient Name*

Name of family receiving the passes. If you are requesting for multiple families, please list additional names in the Additional Information field below.

First Last

Email address of recipient*

We need to have recipient contact information in case we have any questions for them.

Phone number of recipient:*

We need to have recipient contact information in case we have any questions for them.

Additional Information

If you have other special instructions, provide details here.