TRANSPORTATION ASSISTANCE PROGRAM - BUS PASS REQUEST FORM Please note, this form must be completed each semester that you request a bus pass.Name* First Last NSCC A#* Phone Number* Campus email*This must be your @my.nscc.edu email address Please select your main NSCC campus.*White Bridge RoadSoutheastClarksvilleDicksonWaverleyMadisonWhich transit system do you use?* Clarksville Transit System WeGo Transit Do you currently participate in the Snap E&T Program?* Yes No and I am interested in signing up. No and I am NOT interested in signing up. The Supplemental Nutrition Assistance Program (SNAP) Employment and Training helps eligible participants achieve their vocational goals and increase self-sufficiency through funded education, skills training, and supportive services. SNAP E&T services are a combined effort between the Department of Human Services (TDHS), Department of Labor (TDLWD), and community partnerships.Have you completed the FAFSA?* Yes No Are you a Veteran student?* Yes No Are you a TN Promise student?* Yes No Are you a TN Reconnect student?* Yes No Do you paticipate in the Nashville Grad Program?* Yes No If yes, you will receive transportation assistance through the Nashville Grad Program. Do you paticipate in the Nashville FLEX Program?* Yes No If yes, you will receive transportation assistance through the Nashville FLEX Program. Do you currently have a bus pass?* Yes No You will keep your WeGo Transit pass until you are no longer a student at Nashville State. What semester are you requesting a bus pass?* Fall Spring Summer Terms and Conditions*By checking each box, you are indicating that you understand and accept the terms I affirm that I am currently enrolled as a student at NSCC. I understand that my participation in the Transportation Assistance Program is contingent upon my continued enrollment as a Nashville State student. If I withdraw from my classes, my access to the program will be revoked. I understand that participation in this program is a privilege; if I am found to be abusing the privileges of the program (such as sharing my WeGo transit pass with others) my access to the program will be revoked. I agree to notify the NSCC Foundation immediately at (615) 353-3222 if my transit pass is lost or stolen. I understand that if my transit pass needs to be replaced due to loss or theft, I will be required to pay the $10 replacement fee. I understand I must keep my WeGo Transit bus pass until I am no longer a student at Nashville State. CAPTCHAEmailThis field is for validation purposes and should be left unchanged.