Youth Pass Pilot Application The Youth Pass Pilot is a partnership between the MBTA and the City of Boston’s Department of Youth Engagement & Employment, Chelsea Collaborative, the City of Somerville, and City of Malden to offer reduced fare Link passes to eligible 12-21 year olds. The pilot runs from July 1, 2015 to June 30, 2016. Participants can purchase a monthly pass for $26 or a 7-day pass for $7 depending on availability in their city. Youth ages 12-18 are eligible to apply if they live in Boston, Chelsea, Malden or Somerville. Young people ages 19-21 are also eligible if they live in Boston, Chelsea, Malden or Somerville, but must ALSO be enrolled in a qualified program. 1500 participants will be randomly selected from those who fill out this application. If selected, participants will be contacted by their city with further details and instructions for enrolling in the Youth Pass Pilot. The MBTA does not collect information from people 12 or younger. If you are (or your child is) currently 12 you have to apply in person at the participating agency in your city. Email youthpass@mbta.com for directions. * Required 1. Full Name* 2. City where you live* (Check one) Boston Chelsea Malden Somerville 3. Date of birth* (mm/dd/yyyy) 4. On July 1, 2015 I will be * (Check one) 12-18 years old 19-21 years old (must fill out final page) 5. Best Contact Email Address* 6. Best Contact Phone Number* 7. What is the Best Way to Contact You* We will contact you to let you know if you are selected for the pilot. Throughout the pilot, once a month, you will be contacted to answer important questions about using the T. Please select just one of the following: Email address Text message Phone call Preliminary Research Study Questions The Youth Pass Pilot is a research study to measure the costs and benefits of a full Youth Pass for the MBTA. In order to participate in the pilot, you must be willing to answer surveys and have your MBTA trips analyzed (without your name attached to them). Gathering data on youth travel patterns is key to the success of the program; the pass is intended for use only by the applicant. The answers to these questions will not affect your eligibility for the pilot. 8. What is your home zip code? 9. Are you enrolled in middle or high school? Middle school High school Neither 10. Do you have a SuccessLink (formerly BYF’s Hopeline) tracking number? Only for Boston applicants. Yes No 11. If you answered Yes to the above question, please enter your SuccessLink tracking number. 12. How many trips do you normally take on the T (bus and subway) in a week during the school year? One trip is from where you start to where you are going, regardless of how many buses or trains you ride. A round trip, going from home to school or work and then directly back, counts as 2 trips. 13. On a typical weekday during the school year, how many buses and trains do you get on in a day? If you transfer from one train to another, in one trip, that counts as 2. 14. On a typical weekend (Saturday and Sunday) how many buses and trains do you get on (both days combined)? Remember to count your return trips and transfers! 15. How many trips do you normally take on the T (bus and subway) in a week during the summer? Remember a round trip counts as two trips. 16. How do you pay for the T now? Check all that apply. M5 or M7 (Monthly Student Pass) Student Stored Value (S-card) Cash CharlieCard (just one) CharlieCard (multiple) CharlieTicket Weekly Pass Monthly Pass Other: 17. What kind of pass are you more interested in? Your response will not limit you to that selection. $26 monthly, purchased in the last week of the previous month $7 weekly, purchased each week 18. What is your best estimate of the total annual income of your household (everyone living in your house/family)? Less than $22,000 $22,000-$41,999 $42,000-$61,999 $62,000-$99,999 $100,000 or more 19. How do you self-identify by race? You can check multiple. American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White Other: 20. Are you Hispanic or Latino/a? Yes No 21. How did you hear about the Youth Pass Pilot? Check all that apply At my school From my city or youth employment program Job training or education program From a friend On MBTA website Social Media Other The following questions are about further eligibility requirements for 19-21 year olds. If you are 12-18, you may skip this section. 19-21 Eligibility You must also be enrolled in one of the following: high school, alternative education program (does not include college or university), job training program, or receive benefits such as Mass Health. If you are selected to participate in the pilot, we will contact you about verifying that you are enrolled or receive the benefit. I am enrolled in:* You may select multiple. High school A benefit program (for example, Mass Health, food stamps, WIC, public house/section 8, or others) A job training program (for example, Youth Build, Health Careers for Youth, or others) A GED or other adult education program Name of the program or benefit Thank you for filling out this application. Participants will be randomly selected and notified in about a month.
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