Follow the steps to successfully complete your application online.

1. Click ‘Get Form’ button to obtain the application and open it for editing.
2. In the section labeled 'To be completed by Applicant', provide your full name, address, date of birth, height, and telephone number. Ensure all personal details are accurately entered.
3. Indicate your gender by selecting the appropriate checkbox for male or female.
4. If you are a personal representative filling out the form on behalf of a person with a disability, check the appropriate box and fill in your name, phone number, signature, and relationship to the applicant.
5. Once you complete the applicant section, print the form and submit it to a licensed physician or nurse practitioner for certification. They need to complete the 'Physician Certification' section.
6. In the 'Physician Certification' section, the healthcare provider must fill in their name, address, telephone number, licensure title, and license number.
7. The physician must check the appropriate box to indicate whether the impairment or disability is permanent or temporary, and they will provide the estimated period of disability.
8. The physician will select the applicable category of disability from the options provided and must sign and date this section.
9. After both sections are completed, review the entire form for accuracy. Once finalized, you can download, print, or share the form as needed.

Start filling out the NJ Reduced Fare Program Application online today!