Ride VIA to school!

This form must be submitted by or on behalf of the student applying for the VIA Student Pass. Eligible students must be 12 to 18 years of age at the time of application. If the applying student is 13 years of age or older, this form may be submitted by the riding student OR by a parent/legal guardian of the student. If the student applying is under 13 years of age, this form can only be submitted by a parent/legal guardian of the student.

Who is submitting this form?
Student Parent/Legal Guardian of Student

Student's Legal First Name:

Student's Legal Last Name:

Student's age today:

Point of Contact Email:

Type of School:
Public Charter Private Homeschool

By clicking submit, I agree that the details provided in this form are true and correct to the best of my knowledge. I understand that a false statement or information may disqualify me, the applying student (or the student on whose behalf I am applying) from this program. I accept all Terms and Conditions and VIA’s Code of Conduct. View VIA's Privacy Policy