Get Intercity Transit Ada Dial-a-lift Application

This guide provides detailed instructions on how to complete the Intercity Transit ADA Dial-A-Lift Application effectively online. By following these steps, users can ensure that their application is submitted correctly and efficiently, allowing access to essential transportation services.

Follow the steps to successfully complete your application.

1. Click the ‘Get Form’ button to obtain the application and open it in your chosen document editor.
2. Begin by providing your general information in Part 1. Fill in your last name, first name, middle initial, street address, city, state, zip code, date of birth, email address, and phone number. If your mailing address is different, please complete that section as well. Additionally, provide emergency contact information, including the name and phone number of a person who can be reached in case of an emergency.
3. In Part 2, read the certification statements carefully and check all applicable reasons for seeking ADA eligibility. Ensure you sign and date this section, confirming the accuracy of the information. If assistance was provided in completing the form, indicate the name and phone number of the person who assisted you.
4. Proceed to Part 3 to provide information about any travel training you have received, marking the appropriate responses regarding your previous experiences and if you are interested in receiving more information about travel training services.
5. In Part 4, provide information about your medical verification. List health care professionals or rehabilitation facilities familiar with your case and ensure to sign this section, permitting them to release your information to Intercity Transit.
6. Move to Part 5 and check all applicable disabilities that affect your ability to use regular fixed-route buses. Indicate whether your disability is temporary or permanent and list any mobility aids you use. Make sure to answer all listed questions regarding your needs.
7. Complete Part 6 by answering questions about your prior use of regular fixed-route buses, including how often you travel and what assistance you need.
8. Fill out Part 7 with your current travel information by listing three trips you plan to make frequently using Dial-A-Lift.
9. In Part 8, provide details about your Personal Care Attendant if applicable, including their name and contact information. Indicate whether you require PCA services permanently, temporarily, or occasionally.
10. After ensuring all sections have been completed accurately, review the entire application for completeness. You can then save your changes, download, print, or share the form as needed.

Start filling out your Intercity Transit ADA Dial-A-Lift Application online today for better access to essential transportation services.