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ADA Application

Pine Bluff Transit

Application for ADA - Paratransit Eligibility

Pine Bluff Transit provides, to qualifying individuals, Paratransit bus service meeting the requirements of the Americans with Disabilities Act.  This service allows for curb to curb pickup during the normal hours of bus service (6:00 am to 6:00 pm Monday through Friday) and requires you to schedule a ride by 4:00 pm the day before your requested trip.

A pick-up time may be scheduled 1 hour ahead of the requested time and/or 1 hour after, depending on demand.  A 'will-call' may be any time, depending on demand.  In order to process your request to utilize the Paratransit service and determine eligibility, the following pages (1-4) must be completed and returned to Pine Bluff Transit for review.  A determination of eligibility will be made from the information provided.

INSTRUCTIONS:

Applicant:  Completely fill in the information required on pages 1 and 2.  Please sign and date on page 2, line 18. 'Request for Professional Verification will be faxed to your physician or health care official and have your healthcare provider complete pages 3 and 4.  Application may be completed in our office {2300 East Harding}, or mailed to your home address. Once the application is completed, you may mail it back to our office. After your application has been received, we will schedule you to come into our office for a personal interview. A personal interview is part of the application process. (Your application will be considered incomplete without the personal interview).

Physician or Health Care Official:  Complete pages 3 and 4 affixing your signature as noted on page 4.  This document includes 2 pages.  

 

If you have any questions or need assistance in completing this request, please contact Pine Bluff Transit, Paratransit department at 543-5133 / Fax # 543-6975.

 

APPLICATION FOR ADA PARATRANSIT ELIGIBILITY

The information obtained in this certification process will only be used by Pine Bluff Transit for the provision of transportation services.  Information will only be shared with other transit providers to facilitate travel in those areas.  The information will not be shared with any other person or agency.