X hits on this document

29 views

0 shares

0 downloads

0 comments

4 / 11

Address:_____________________________________________________________________

City, State, Zip:________________________________________________________________

Daytime Phone:______________________________ Evening Phone:____________________

Please describe the disability or health condition that prevents you from using fixed route buses (Valley Metro).  Please list all disabilities or health conditions that apply.

____________________________________________________________________________

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Is this disability or health condition temporary?  _____Yes _____ No

If yes, how long do you expect it to prevent you from using fixed route buses?

__________ months

Do you ever need to bring someone with you when you travel (a personal care attendant)?

Yes, always Yes, sometimes No

How do you currently travel to your most frequent destinations?

 Bus  Drive Myself  Taxi  Someone drives me

SECTION B:   ABILITIES TO RIDE FIXED ROUTE BUSES

Please read the following statements and check those which best describe your abilities to use fixed route buses.  (Check all that apply).

Fixed route buses means the large city buses operated on set routes by Valley Metro.

I can get to and from bus stops if the distance is not too great.

I can ride the bus when I am feeling well.  There are other times, however, when my disability or health condition worsens, and at these times I cannot ride the buses.

I have a disability or health condition which prevents me from riding the buses or trains if the weather is very hot or very cold.

Page 4

Revised 6/14/07

Document info
Document views29
Page views29
Page last viewedMon Dec 05 14:02:52 UTC 2016
Pages11
Paragraphs199
Words2245

Comments