Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out your personal information. Include your full name (last, first, middle), address (street, city, zip code), and contact numbers (phone, cell). Additionally, provide your email address and date of birth.
3. Indicate whether you completed the application independently. If not, have the person assisting you fill out Part B of the certification on page 5.
4. Provide the name and phone number of a contact person who can arrange an interview or evaluation appointment for you, if different from the applicant.
5. List a local emergency contact with their name, relationship to you, and phone numbers for daytime and evening.
6. Attach all relevant information regarding your disability including documentation from a qualified professional. Make sure this includes specific details relating to your functional abilities.
7. Clearly describe your disability or condition that may qualify you for the Metro Mobility ADA Paratransit Service. Be as detailed as possible.
8. Explain how your disability affects your ability to use fixed-route city bus services.
9. Indicate the mobility aid or equipment you use when traveling. Select all that apply from the provided options.
10. If you use a wheelchair, provide additional information regarding its type, weight alongside you, and measurements (length, width, make, and model).
11. Answer questions regarding personal care attendant assistance, your ability to travel to the curb, and identify any barriers you face to accessing bus stops.
12. Discuss your capabilities when riding the fixed-route bus, including your independence in asking for assistance, grasping railings, and counting fare.
13. Mention if you require travel training and how you would manage with the bus independently or with assistance.
14. Provide any further information that could help evaluate your mobility level.
15. State your need for bus information in an alternative format if required, and indicate which formats are acceptable to you.
16. Review your application to ensure all questions are answered, then proceed to sign and date the application.
17. Submit the completed application either by mail, email, or fax as indicated on the form.

Complete your application online to ensure a smooth and efficient process for accessing Metro Mobility services.