OUSD Gateway to College High at Laney College

Student Transit Pass Application

Alameda County Student Transit Pass Program

Oakland Unified School District

Gateway to College High at Laney College

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 AC Transit. 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

Welcome

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

Yes. If you select this option, please do NOT fill out this form. No. If you select this option, please complete this form.

Please note that your card is valid until you graduate from high school. If you’ve already enrolled in the program and received an STPP card in the past, you do not need to submit another application at this time.

Lost your STPP Clipper card and need a replacement?

If you have lost your card, you can replace your pass online or by phone. Visit http://www.clippercard.com or call Clipper Customer Service at 877-878-8883. Clipper customer service is open Monday – Friday, 6 a.m. to 8 p.m., and Saturday and Sunday, 8 a.m. to 5 p.m. Tell the customer service representative that your Clipper card is a “Student Transit Pass.

It is helpful to have the serial number of your lost card on hand, but it is not required to replace your card. Your replacement card will be sent to your house (to the address you put on your application), not to your school.

If you need additional support, please call your school and speak to the STPP administrator.

PLEASE DO NOT PRESS SUBMIT

Student Contact Information

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

School Name*

Gateway to College High at Laney College 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.

Grade*

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 No

If known, please provide the 10-digit card number associated with your existing Youth Clipper card.

Is this card lost or stolen? *

Yes (a card will be created for you) No (you will not receive a new card, a Student Transit Pass will be added to your Youth Clipper card if you provided a 10-digit card number above)

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*