Please fill out the application below to provide information about your disability/limitation that prevents you from utilizing fixed-route transportation. An application is complete once both the applicant and a qualified healthcare provider fill out their respective applications. Applicants should expect to be contacted within 1-2 business days once both applications have been received in order to schedule a brief in-person assessment.
Please fill out the application below to provide information about your disability/limitation that prevents you from utilizing fixed-route transportation. An application is complete once both the applicant and a qualified healthcare provider fill out their respective applications. Applicants should expect to be contacted within 1-2 business days once both applications have been received in order to schedule a brief phone-based assessment.
Click to fill out Medical Verification Form online