Mass Transit Request Form
********************INCOMPLETE FORMS WILL NOT BE CONSIDERED********************

The Lang Center for Civic and Social Responsibility supports the efforts of students to be engaged in volunteer activity which has as one of its primary goals serving the public good in nearby areas by helping to make mass transit possible if needed and within its budgetary limits. Requests for transportation support in the form of public transportation can be made by completing the form below. Please note: Each individual student must make her/his/their own request using this form. Students are not permitted to submit a mass transit request for other student(s).

Faculty whose coursework includes community-based learning components are asked to submit a single request for the entire class with the names of each student indicated on the form, and then upon approval, collect the passes from the Lang Center for distribution to the class members.

All requests MUST be submitted in advance, preferably at the beginning of a semester. There will be no same day service/distribution of passes, NO EXCEPTIONS! Mass transit assistance requests may be fulfilled from the first day of classes until the last day of classes during each academic term. In exceptional circumstances, students may request an extension of mass transit support outside of this time period but a letter, email, or phone call of support from the host site will be required in addition to the completion of this form.

If your request is approved, you are agreeing to use mass transit support for yourself or the individuals listed on this form and for only those service activities described herein, to turn in a completed Release of Liability form, and also to ensure that you have obtained the necessary clearances for work that involves minors (people under the age of 18).  Violation of this agreement may negatively impact your eligibility for future mass transit support. The Lang Center reserves the right to confirm your terms, attendance, and performance of service by calling your site supervisor.

Exclusions: This is a SEPTA Independence Pass program; the Lang Center does not replace lost/stolen/misplaced Independence Passes. The Lang Center cannot support mass transit requests for paid employment.
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Email *
Your name *
Student ID # *
Class Year *
Please list the semester and year for this request. (ex.  Fall 2021, Spring, 2022) *
Is this transportation request in connection with an Engaged Scholarship (ESCH) course? *
If yes, write course number, course name, and professor's name.
Name of community service organization or political engagement initiative *
Name of your contact person at the community service organization or political engagement initiative *
Contact person phone number and email address *
What is the mission of this community service organization or political engagement initiative you'll be volunteering with? *
Please include web address.
What will your volunteer work entail? *
Please be as specific as possible.
What is the start date? *
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YYYY
What is the anticipated end date? *
MM
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YYYY
How many hours of service -- not including travel time -- will you provide during one excursion? *
How many times per month will transportation be needed? (Total # of trips per month)? This information will be confirmed with a site supervisor. *
Note: If this is an ongoing volunteer experience, a new mass transit request form will need to be completed at the start of each new academic term.
Local transportation is needed to/from: (ex. Swarthmore College to/from 123 College Lane, Philadelphia, PA 19103) *
FACULTY ONLY: Please provide the list of students in your class who will be traveling to/from the location of this event, initiative, or volunteer placement.
FACULTY ONLY: Will the same number of people travel to the same destination each time?
Please explain.
Is this transportation request in connection with paid employment? *
Required
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