Cycle to Work Scheme Application Form for Teachers and Non-Teaching Staff

Department of Education

Cycle to Work Application Form

Applicant Name

Address

Eircode

Contact Phone Number

Contact Email

School Roll No

Part 1 – Applicant Details

Payroll No

PPS No

Sector

Part 2 – Supplier Details

Supplier Name

Supplier Address

Country

Supplier Eircode / Postcode

Supplier Contact Email (For Remittance)

Part 3 – Supplier Payment Details

Invoice Number

Invoice Amount (Euro)

Primary Teacher Post Primary Teacher

Primary Non Teaching Staff Post Primary Non Teaching Staff

Appendix 2

Version 2.0 August 2023