VANPOOL SPONSORSHIP PROGRAM
APPLICATION
INSTRUCTIONS
Each
vanpool group must provide a complete application package
to the TMA in the county in which the group works.
The
complete application includes:
-
A
Vanpool Application form (which details the operations
of the vehicle itself).
-
A
Vehicle Trip Sheet (which
details, on one day only, the distances traveled
by the vanpool’s passengers). This sheet is a 2-sided
form that must be completed for both the Workbound and
Homebound trips on any one day. It lists all participating
passengers, their status, the length of their trip and
their pick-up and drop-off locations. Please include
all participants on this form, even if they are not riding
on the day the sheet is completed. Completing
this sheet will ensure consistency in the reported distances
traveled in the van by passengers who travel between the
same points. You will find it easiest to group riders
that share the same origin and destination. Please fill
out the entire form.
-
An
Individual Application form for each Vanpool member including
the driver and any part-time or substitute riders.
If
a vanpool member takes the vehicle home, the distance he/she
travels between home and the first location where other members
are picked up should be included in the driver’s mileage in
the van. This home location is also the origin of the van.
Please
remember that your responsibilities, as driver/coordinator,
include advising the TMA if someone leaves your vanpool as
well as providing the TMA with an Individual Application
form for any new riders who may join during the year.
If someone leaves, provide the TMA with a copy of the Vehicle
Trip Sheet (both sides) with the name crossed through.
If someone joins, send the TMA the new Individual
Application along with a copy of the Vehicle
Trip Sheet (both sides) with the new name and mileage
added onto it.
Please
note: If you transfer from one vanpool provider to another,
your acceptance into this program DOES NOT automatically transfer.
You must provide the TMA with a new Vanpool Application that
will be forwarded to NJ TRANSIT. If any of the vanpool members
have changed since the original application, new forms should
be included.
Definitions
-
A
full-time rider is someone who essentially commutes
in the van 5 days a week, with the exception of vacation,
illness or occasional business travel.
-
A
part-time, substitute or occasional rider is someone
who commutes on the van on an irregular basis. This
person’s Individual Application should reflect an estimate
of the number of days in a typical week the person uses
the van. A person who travels less than 5 days a week,
even if they travel the same days every week, IS NOT
a full time rider. They are a part-time rider.
Please
complete all applications legibly, in either black or blue
ink. Make sure to keep a copy of the complete application
package for your records, particularly so that you can send
a revised Vehicle Trip Sheet (both sides) when someone leaves
or a new member joins.
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| 1.
TMA applied to: |
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| 2.
Vanpool provider: |
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3. Vanpool Provider's Vehicle ID #: |
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| 4.
Name of Driver/Coordinator: |
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| 5.
Email address of Driver/Coordinator: |
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| 6.
Is this application |
new
a renewal
new Driver/Coordinator
|
| 7.
Origin of Vanpool:
(Include municipality, county or borough,
state and zip code) |
|
| 8.
Van Start Time: |
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| 9.
Intermediate Stops: |
|
| 10.
NJ final destination:
(Include employer name, municipality, county or borough,
and zip code.) |
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| 11.
Time arrived at final destination: |
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| 12.
Please list highway numbers/names travelled: |
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| 13.
Days of the week the vanpool generally operates: |
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| 14.
Total daily mileage vanpool travels: |
Workbound:
miles
Homebound:
miles |
|
15. Does this vanpool qualify for the Vanpool Sponsorship Program
upgrade? ($300/month?)
|
No
Yes, we travel on the NJ Turnpike's HOV lane
(only valid for travel
from Exit 11 to 14 between 6 AM and 9 AM OR from Exit 14 to 11
between 4 PM and 7 PM) |
| |
Workbound
from Exit
to Exit
|
| |
Homebound
from Exit
to Exit
|
| |
Yes, we travel on I-80, in either direction, between
the Garden State Parkway and I-95 in Ridgefield. |
| 16.
Number of Vanpool participants: |
Full-time
|
| |
Part-time,
substitute, or occasional
|
| 17.
Van departure time
(at end of work day) |
|
My signature below indicates that the information contained in
this
Vanpool Application Form is valid and accurate, to the best of
my knowledge.
|
| Enter
in Name of Driver/Coordinator: |
|
| Date: |
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| Signature
of Driver/Coordinator: |
________________________ |
| Date: |
________________________ |
| |
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