Cal State LA U-Pass Student Information Form Header Image

Cal State LA U-Pass Student Information Form

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.

Name*
If you currently ride Metro, what type of fare do you use?*
"Pay as you go" - How many times a week do you ride Metro?*
Units currently enrolled in at Cal State LA:*
Are you currently enrolled at another college?*
Current employment status:*
Age:*
Ethnicity:*
Annual household income:*
How many people are in your household? (Including yourself)*

By accepting the U-Pass card from my school, I hereby grant LACMTA permission to release periodic reports of my TAP card activity including date, time and service used (bus route or rail station) to my school.


I also agree to use the TAP card in accordance with the terms of the TAP Cardholder Agreement (available at http:www.taptogo.net or by contacting 1-866-TAPTOGO) and the Metro Customer Code of Conduct (available at https://media.metro.net/about_us/ethics/images/codeofconduct_customer.pdf), for its intended purpose only and not to damage, abuse or allow any other unauthorized individual to use it.


By submitting this form, I agree to receive future communications from Metro including emails, social media and digital remarketing.

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