Is there anything else you want to tell us about the applicant’s disability or health information that might help us better understand the applicant’s travel abilities and limitations?
I understand that the purpose of this application is to determine if the applicant is eligible to use ADA Paratransit Services. I certify that the information provided in this application is true and correct. I understand the falsification of the information may result in denial of service to the applicant. I understand that all information will be kept confidential.
I certify that the information in this application is true and correct and I understand that giving false or misleading information may result in denial of ADA Paratransit Services. I understand that all information will be confidential to the extent possible, and used to determine my eligibility for paratransit services.