Get Application For Uplift Ada Paratransit Service - Lima/allen County ...

Completing the Application For UpLift ADA Paratransit Service is an important step in accessing the transportation services you need. This guide will provide clear, step-by-step instructions for filling out the application online, ensuring that you provide all the necessary information to help us serve you better.

Follow the steps to fill out the application effectively.

1. Click the ‘Get Form’ button to retrieve the application and open it in your preferred online editing tool.
2. Indicate whether this is a new application or a renewal by checking the appropriate box.
3. Fill in the card number, date issued, and expiration date if applicable.
4. Complete the personal details section, including last name, first name, initial, address, city, and zip code.
5. Provide your date of birth in the specified format and select your gender.
6. Include your daytime and evening phone numbers for contact purposes.
7. Enter your OH HealthNet Card number if applicable.
8. Select your racial/ethnic data from the provided options to comply with reporting requirements.
9. Add the emergency contact details including their name, relationship, and phone numbers.
10. Fill out the mobility information section, checking all mobility aids or equipment you use and providing details about your mobility capabilities.
11. In the disability or health condition section, indicate all conditions affecting your ability to use regular bus services.
12. Offer detailed descriptions of how your disability affects bus usage, and determine if your condition is temporary.
13. Complete the additional questions regarding your ability to travel, communicate, and manage unexpected situations.
14. Sign and date the application at the designated area to certify that the information is true and correct.
15. If someone else is completing the form, check the appropriate box and provide their information.
16. Professionals must fill out the verification section, certifying the applicant's condition and ability to utilize bus services.
17. Once all fields are completed, save your changes, and choose to download, print, or share the completed application as needed.

Complete your application online today to access the UpLift ADA Paratransit Service.