Middle/High School Student Free Bus Pass Form
 Parents, please fill out this form for each student. Student's name and school will be shared with entities handing out passes. All other information will be keep confidential and used to determine funding source of passes. All students will receive a pass, regardless of answers.

After filling out this form, you or your student can pick up a sticker for your student's ID card which can be used to ride GVT fixed route free.

Stickers can be picked up at the following locations: your child's school, D51 Administration Building, GVT Downtown or West Transfer Facility, Mesa County Libraries
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Head of Household's First and Last Name *
Head of Household's Last 4 Digits of Social Security Number *
Email address for information about bus pass program and travel trainings (optional)
Student's First and Last Name *
School attending for 2021-2022 school year *
Student age *
Is your student lawfully present in the United States (optional)?
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What is your household monthly income (include all earned wages, social security income, child support, and any other income. Do not include SNAP or LEAP benefits)? *
What is your household size?  (Include children and adults) *
I swear and affirm, under penalty and under the laws of the State of Colorado that the information I have provided in this application is true and correct.  I understand that falsification of information will result in denial of service.  I also understand that all information will be kept confidential. I understand that these passes are solely for the transportation of the person it was issued to. *
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