Compton College U-Pass Student Information Form

The Universal College Student Transit Pass (U-Pass) offers UNLIMITED rides on all Metro bus and rail. Save money and time with greater fare discounts and an expedited activation process that is administered directly on campus. Check out your college website for more information.

1. Student ID#:*

2. Name*

First Name

Last Name

3. Email*

4. Zip Code*

5. How many miles do you live from school?*

Example: 3.5

6. If you currently ride Metro, what type of fare do you use?*

College/Vocational pass Regular 30-day monthly EZ Pass Pay as you go (cash/TAP) I don't ride Metro

7. "Pay as you go" - How many times a week do you ride Metro?*

2 4 6 8 10 12 14 or more

8. If you have a TAP card, please provide the 16 or 20-digit card number (located on the back of the card) or enter N/A (non-applicable):

9. Units currently enrolled:*

0 - 5 units 6 units 7 units 8 units 9 units 10 units 11 units 12 units or more

10. Are you currently enrolled at another college?*

Yes No

10.a. What other college are you enrolled in?

10.b. How many units are you taking at the other college?

11. Expected graduation date: Quarter/Semester*

11.a Expected graduation date: Year*

The information below is requested as part of Metro’s Title VI reporting requirement to the Federal Transit Administration (FTA). The FTA requires that all direct recipients of Federal funding document their compliance with the Department of Transportation’s Title VI regulations. Title VI consists of numerous requirements, including Fare Equity Analysis for Fare Changes. Metro must secure demographic data for all participants of the U-Pass Pilot Program and report aggregated data back to the Metro Board of Directors within the first 6 months. No individual data will be shared. Thank you for your assistance with this matter and for ensuring that Metro meets all federal requirements. If you have any questions regarding the Title VI Reporting requirements, please feel free to contact the Office of Civil Rights at (213) 922-2403.

12. Current employment status:*

Full-time Part-time Not employed

13. Age:*

17-21 22-25 26-30 Over 30

14. Ethnicity:*

Asian Or Pacific Islander Black Hispanic Native American White Two or more

15. Annual household income:*

Under $15,000 $15,000-$24,999 $25,000-$34,999 $35,000-$49,999 $50,000-$99,999 $100,000-$149,999 $150,000-$199,999 $200,000 and over

17. I agree (opt in) to receive future communications regarding products and services offered by Metro, a business partner, or the entity with which Metro contracts for the TAP system, using my contact information provided above.*

Yes No

I understand that my school is participating in the Metro Universal Pass Program (U-Pass) with the Los Angeles County Metropolitan Transportation Authority (LACMTA/Metro). I understand as a part of the Metro U-Pass, I will be issued a TAP Card/Sticker. I understand that my TAP Card/Sticker is nontransferable and cannot be used to cover transit boardings for any other person, including family members or friends.

I consent to my school assembling on behalf of Metro and providing to Metro, information Metro requires in order to implement the billing, account settlement, enforcement, or other financial activities of the Metro U-Pass program, or for the purpose of creating an integrated transit fare payment system. Such information includes but is not limited to my name, Metro U-Pass ID number, school ID number, and my completed and signed online application.

I will use the TAP Card/Sticker in accordance with the terms of the TAP Cardholder Agreement (available at www.taptogo.net or by contacting 1-866-TAPTOGO) and the Metro Customer Code of Conduct (available at http://media.metro.net/about_us/ethics/images/codes_ethics_customers_2014-07.pdf) for its intended purpose only and not to damage, abuse or allow any other unauthorized individual to use it. Metro and/or any Los Angeles County law enforcement agency retains the right to confiscate a TAP Card/Sticker or pursue claims, demands, or lawsuits against, or seek prosecution of, any person who duplicates, alters, or commits unauthorized use of a TAP Card/Sticker. No credit or refund will be issued for proration of unused balances to participant should Metro or any Los Angeles County law enforcement agency confiscate TAP Card/Sticker, pursuant to this section. Misuse of a TAP Card/Sticker will result in deactivation of the TAP Card/Sticker by Metro. Metro may refer any information regarding such events to authorities for prosecution.

18. By clicking "Agree" I am agreeing with the statement above:*

Agree Disagree

19. Signature*

[clear]

Use your mouse or finger to draw your signature above

Compton Community College U-Pass Student Information Form