Rides to Hope
Application Form

This form helps us understand your situation and arrange free or subsidised safe transport through the Shebah platform, delivered by Safe Transport Australia.

The form takes approximately 5–10 minutes to complete.

🔒 Your privacy matters All information you provide is kept strictly confidential. We will only contact you using the details and method you choose in this form. You can tell us how to keep your information safe.

Section 1 of 4

About You

Please share your personal details. Only share what you feel comfortable sharing.

Full Name * Include preferred name if applicable Please enter your name

Date of Birth * Please enter your date of birth

Email Address Only if it is safe to contact you by email

Suburb & Postcode * Please enter your suburb and postcode

Contact Number * Please enter a contact number

Is this number safe to contact you on? * By either a Rides to Hope staff member or driver

Yes No

Please select an option

Preferred method and hours of contact

Is it safe for us to mention Rides to Hope or Shebah when contacting you? *

Yes No

Please select an option

What can we say if someone else answers?

Your Pronouns

Do you identify as any of the following? * Select all that apply

Aboriginal or Torres Strait Islander Culturally and Linguistically Diverse (CALD) Living with a disability Experiencing or escaping domestic / family violence Experiencing homelessness or housing insecurity Single parent or primary carer Prefer not to say

Please select at least one option

Are you currently supported by a charity, community organisation, or case worker? *

Yes No

Please select an option

Please provide further details Name of organisation, case worker or support coordinator, and the nature of support provided

Section 2 of 4

Reason for Enquiry

Help us understand why you're requesting a discounted ride through Rides to Hope.

Why are you requesting a discounted ride? * e.g. financial hardship, safety concerns, disability, no access to transport Please describe your reason

What is the purpose of this trip? *

Medical or health appointment Legal or court appointment Housing or accommodation Employment or job interview Education or training Government or Centrelink services Escaping an unsafe situation Support services appointment Other

Please select at least one option

Are you currently receiving any government support or Centrelink payments? *

Yes No Prefer not to say

Please select an option

Do you have access to any other safe or reliable form of transport for this trip? *

Yes No

Please select an option

Why is it not suitable for this journey?

Section 3 of 4

Trip Details

Tell us about the ride you need. Please provide as much detail as you can.

Date and Time of Trip * Approximate is fine if exact time is not yet known Please provide the trip date and time

Pickup Address * Please enter a pickup address

Drop-off Address * Please enter a drop-off address

Safety or special pickup instructions * e.g. wait down the road and message when arrived; take off Shebah-branded car stickers; enter via back gate Please provide pickup instructions (enter "none" if none apply)

How many people will be travelling? * Including number of children Please enter the number of passengers

Do you require any of the following for the ride?

Child car seat (infant, 0–6 months) Child car seat (toddler, 6 months–4 years) Booster seat (4–8 years) Wheelchair accessible vehicle Extra luggage or bag space

Any further requests for your driver? * e.g. no music in car, no talking, prefer quiet trip Please enter your requests or write "none"

Section 4 of 4

Consent & Declaration

Please read and respond to each statement below before submitting your application.

🌸

Application Received

Thank you for reaching out. A member of the Rides to Hope team will be in touch using your preferred contact method to confirm your trip details.

If you have any urgent concerns, please contact Safe Transport Australia directly.

Rides to HopeApplication Form

Application Received

Rides to Hope
Application Form