Get Ada Application For Transportation Service (.pdf) - Dutchess County ... - Co Dutchess Ny

Filling out the ADA Application for Transportation Service is an important step for individuals seeking access to transportation services provided by Dutchess County. This guide will walk you through each section of the application to ensure a smooth and successful submission.

Follow the steps to complete your application online.

1. Click 'Get Form' button to obtain the application and open it in an electronic format.
2. Begin by entering your personal information. This includes your name (last, first, and middle initial), address, and phone numbers. Make sure to provide accurate details for effective communication.
3. Indicate the type of service you are applying for by checking the relevant boxes: ADA, Dial-A-Ride, or Flex. It's important to select the appropriate service to match your needs.
4. Next, check any reasons that apply to your need for transportation services, such as difficulty standing outside for over 10 minutes or walking more than 200 feet. Make sure to provide any additional explanations if 'Other' is selected.
5. Answer whether your mobility limitation is permanent. If it is not, provide an estimate of how long you expect to need these services.
6. List the mobility aids you use, if any, by checking all that apply (scooter, wheelchair, walker, cane, service animal, etc.).
7. Indicate if you travel with a personal care attendant and mention any special needs the dispatcher should be aware of when scheduling trips.
8. Provide emergency contact information, including the person's name, address, phone numbers, and their relationship to you.
9. If applicable, indicate if you are a client of a community service agency and provide contact details for the agency.
10. Provide the name and contact information for a healthcare professional who can act as a reference to verify your eligibility.
11. Finally, review your entire application for accuracy, then sign and date the document to confirm that the information provided is true and complete.
12. After completing the form, you can save your changes, download a copy for your records, print the application, or share it as needed.

Take the first step towards accessing transportation services by completing the ADA application online today.