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.

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

Additional Information

If you have other special instructions, provide details here.

Pass Pickup

Passes can be picked up at 2020 Bonar Street - OFEE staff can find them in the OFEE box in the mailroom.