Get Eligibility And Registration Form - Westmoreland Transit

Completing the Eligibility And Registration Form for Westmoreland Transit online is a straightforward process designed to assist individuals in securing the necessary transportation services. This guide will provide you with clear and detailed instructions on how to accurately fill out each section of the form to ensure your eligibility is properly evaluated.

Follow the steps to complete the form online effectively.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering the recipient identification details including your last name, first name, middle initial, social security number, date of birth, and phone number. Ensure that all information is accurate and clearly printed.
3. Fill in your street address, apartment number (if applicable), city, municipality, county, and state. Don't forget to include your zip code.
4. Provide the emergency contact information by entering their name, relationship to you, and phone number.
5. Review the recipient release section carefully. This part states that the information you provide will be used for determining your eligibility for transportation services and will remain confidential. After reading, sign and date the form.
6. If you are unable to sign due to a minor status or disability, have a designated person sign on your behalf and provide their relationship to you.
7. Complete the physician certification section by checking all relevant disabilities that apply. Also, indicate any disability services you receive or are eligible for.
8. In the limitations section, specify the tasks that the individual cannot do when using public transit. Select how often these limitations apply and provide details for any temporary limitations.
9. Indicate whether a personal care attendant or escort is needed for medical reasons while traveling, and provide an explanation if applicable.
10. Finally, the physician must sign, print or type their name, provide office details, including phone and fax numbers, and state their Pennsylvania license number. Ensure all information is complete and correct before submitting.

Complete your Eligibility And Registration Form for Westmoreland Transit online today to secure your transportation services.