<%@LANGUAGE="VBSCRIPT" CODEPAGE="1252"%> Vanpool Sign Up Form
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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 vanpoolís 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 driverís 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 personís 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.

1. TMA applied to:
 
2. Vanpool provider:
 
3. Vanpool Provider's Vehicle ID #:
 
4. Name of Driver/Coordinator:
 
5. Email address of Driver/Coordinator:
 
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:
9. Intermediate Stops:
 
10. NJ final destination:
(Include employer name, municipality, county or borough, and zip code.)
 
11. Time arrived at final destination:
12. Please list highway numbers/names travelled:
 
13. Days of the week the vanpool generally operates:
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:
Signature of Driver/Coordinator:
________________________
Date:
________________________