Fillable The TAC L2P - Learner Driver Mentor Program (Department of Infrastructure, Transport, Cities and Regional Development)

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The TAC L2P - Learner Driver Mentor Program (Department of Infrastructure, Transport, Cities and Regional Development)

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Country of origin: AUSTRALIA
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The TAC L2P - Learner Driver Mentor Program helps learner drivers aged 16 to 23 years
old, who do not have access to a supervising driver or vehicle, gain the driving experience
required to apply for a probationary licence.
The TAC L2P program is FREE for ELIGIBLE young people who live in the City of Casey.
Learner drivers are matched with a fully licensed volunteer mentor and have access to a
sponsored vehicle, which they can use to get supervised driving experience and work
towards their 120 driving hours.
Please note there is currently a 12 month wait list for eligible applicants.
Email
caseycc@casey.vic.gov.au
Post
PO Box 1000
Narre Warren VIC 3805
Phone
03 9705 5200
NRS
133 677
(for the deaf, hearing or speech impaired)
TIS
131 450
(Translating and Interpreting Service)
facebook.com/CityOfCasey @CityOfCasey
City of Casey is committed to protecting your privacy. Your personal information will be handled in accordance with the
Privacy and Data Protection Act 2014. All personal information collected by the City of Casey will only be used for the
purpose outlined within our Privacy Policy. Council’s Privacy Policy is available from our website www.casey.vic.gov.au
and all Council Customer Service Centres. For further information about how Council manages and uses your personal
information or how you can access and/or amend your personal information please contact Council’s Privacy Officers
via our website www.casey.vic.gov.au or by calling on 9705 5200.
Overview
L2P Learner Driver Application
Lodgement
Contact
Privacy Statement
Title Surname Given Names
Preferred Name Gender
Home Address
Suburb/Town State Postcode
Home phone Mobile
Email
Date of Birth Birth Country
Arrival Date in Australia
Are you Aboriginal or Torres Strait Islander descent?
Primary
Language
Spoken
Other
Languages
Spoken
Referral name
(if applicable)
Referral
organisation
Referral phone
number
Title Surname Given Names
Relationship
Street Address
Suburb/Town State Postcode
Home phone Mobile
Do you currently have access to a supervising driver and/or vehicle?
Do you currently have a Healthcare card and/or receive Centrelink benefits?
If yes, give brief details
Are you, your parent or guardian currently impacted by family violence, mental or physical
health issues?
Are you a twin or triplet?
Are you a single parent?
Have you recently experienced periods of homelessness?
Have you recently experienced out-of-home care?
Have you been involved with the Justice system in anyway? (if yes, note that this will not
affect your chance of being involved in the program, it will help us help you). If yes, please
provide more details
Case worker Phone
Applicant’s details
Emergency Contact
Current circumstances
Monday
7.00am - 9.00am 9.00am - 12.00pm
12.00pm - 3.00pm
3.00pm - 5.00pm 5.00pm - 7.00pm 7.00pm - 10.00pm
Tuesday
7.00am - 9.00am 9.00am - 12.00pm
12.00pm - 3.00pm
3.00pm - 5.00pm 5.00pm - 7.00pm 7.00pm - 10.00pm
Wednesday
7.00am - 9.00am 9.00am - 12.00pm
12.00pm - 3.00pm
3.00pm - 5.00pm 5.00pm - 7.00pm 7.00pm - 10.00pm
Thursday
7.00am - 9.00am 9.00am - 12.00pm
12.00pm - 3.00pm
3.00pm - 5.00pm 5.00pm - 7.00pm 7.00pm - 10.00pm
Friday
7.00am - 9.00am 9.00am - 12.00pm
12.00pm - 3.00pm
3.00pm - 5.00pm 5.00pm - 7.00pm 7.00pm - 10.00pm
Saturday
7.00am - 9.00am 9.00am - 12.00pm
12.00pm - 3.00pm
3.00pm - 5.00pm 5.00pm - 7.00pm 7.00pm - 10.00pm
Sunday
7.00am - 9.00am 9.00am - 12.00pm
12.00pm - 3.00pm
3.00pm - 5.00pm 5.00pm - 7.00pm 7.00pm - 10.00pm
All applications require a copy of your Learners Permit attached
Learner’s Permit No. Expiry Date
Learner Permit Conditions (e.g. glasses or corrective lenses)
Mentor Preference
Have you had any driving experience?
If yes, how many hours?
In what vehicle type?
Why do you want to be part of the TAC
L2P Program?
What are your interests?
Do you have commitments or activities
that may impact your participation?
Do you have a physical or mental
health diagnosis that may impact your
ability to drive safely? Please give
details including current treatment.
Are there any other issues that may
impact your involvement in the
program?
If you are aged 21 to 23, do you
commit to at least 40 hours driving
practice with the program?
Additional information
Availability
If you are successful in applying for the Casey TAC L2P program, do you:
Agree to make my involvement in the program priority (making time to attend driving
lessons and mentor driving session as much as possible)?
Agree to make myself available to mentor to undertake mentor driving sessions?
Agree to respond to all communications in a timely manner (responding to all texts, emails
or calls as soon as you can)?
Agree to only cancel appointments for valid reasons and in a timely manner (eg at least 24
hours before)?
Acknowledge that I may lose my place on the program if I fail to follow the above rules.
Acknowledge that lesson will only be offered in an automatic car.
I understand and acknowledge that:
» The information provided in this application is true and complete to the best of my knowledge
» I have included a copy of my current Learners Permit
» I will be contacted once a place comes available
Do you consent for your relevant health and personal information provided in this
application form to be shared with Department of Transport, our driving instructor and
your allocated mentor driver. Information will only be shared if it is relevant and required.
By marking this checkbox, I can confirm that I have read and understood all the
statements above and included copies of the required documentation.
Applicants Signature Date
Parent/Guardian signature required for all Participants under the age of 18 years.
Parent/Guardian first name Surname
Relationship to Applicant Date
Declaration
Agreement questions
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The TAC L2P - Learner Driver Mentor Program (Department of Infrastructure, Transport, Cities and Regional Development)

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Completed 20 November 2020

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