LVJUSD Joe Michell

Student Transit Pass Application

Alameda County Student Transit Pass Program

LVJUSD Joe Michell

Application Instructions

To enroll in the Student Transit Pass program, complete the below application. All fields marked with an asterisk (*) are required.

Eligible students get a FREE Youth Clipper card that provides unlimited free rides on Wheels. Students can add cash value to the Clipper card for 50% off BART fares and youth discounts on other transit systems that use Clipper.

For more information about program eligibility visit: https://www.alamedactc.org/programs-projects/studentpass/

Review Clipper Cardholder License Agreement and Metropolitan Transportation Commission Privacy Policy at:

https://www.clippercard.com/ClipperWeb/agreement.do/

https://www.clippercard.com/ClipperWeb/privacy.do/

District

School

School Name*

Joe Michell Other

You are using the incorrect application, please do NOT submit this form. Please use the link below to find the correct application for your school.
Link: Student Transit Pass Program - Alameda CTC.

Student Contact Information

Have you received a Student Transit Pass Clipper card this year or in past years?*

Yes No

If yes, YOU DO NOT NEED to submit a new application, your card is VALID UNTIL YOU GRADUATE from high school. However, if your card has been lost or stolen, you can request a replacement card using this form.

Do you currently have a Student Transit Pass Clipper card that you HAVEN'T used in the last 6 months?*

Yes No

If you haven't used your card in 6 months, it might have become inactive. YOU DO NOT NEED to fill out this application. Please EMAIL STPP@LAVTA.ORG with your Clipper Card Number to request reactivation for your card. For any further questions, you may call 925.455.7500.

Student Name*

First Name

Middle Name (optional)

Last Name

Suffix (optional)

Student Date of Birth*

This information must match school records

Home Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Home Phone

Student Grade Level*

Student ID Number*

This information must match school records

Student Email Address

Confirm Student Email Address *

Does the student have an existing Youth Clipper card?*

Yes, please add the STPP pass to the student's existing card No, the student is new to the STPP program and needs a card No, the student enrolled in the STPP program previously and needs a replacement card

Please provide the 10-digit card number associated with your existing Youth Clipper card.*

Parent or Guardian Signature

By signing, I (parent/guardian) attest that the information on this application is correct.

Parent or Guardian Signature*

[clear]

Use your mouse or finger to draw your signature above

Date*