Fillable Paratransitapplication10262017

Fill Online, Printable, Fillable, Blank Paratransitapplication10262017 Form

Use Fill to complete blank online TOWSON UNIVERSITY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Paratransitapplication10262017

On average this form takes 7 minutes to complete

The Paratransitapplication10262017 form is 1 page long and contains:

  • 1 signature
  • 0 check-boxes
  • 23 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Towson University

BROWSE TOWSON UNIVERSITY FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
PARATRANSIT SERVICES APPLICATION
Passenger Information
Name (Last, First, M.I.) _______________________________ TU ID # _________________________
Email Address _______________________________ Phone # (_____) ___________________
Disability Information
Please circle all that apply:
I can use the Towson University shuttles, but only if lift-equipped. Y N
I need assistance to board and / or exit the Towson University shuttles. Y N
Please be aware that drivers can only provide assistance getting on and off the bus.
Please list any concerns or medical conditions you feel the driver should be aware of in order to serve you
better. (Ex. Fainting spells, seizures, navigation deficits, etc.):
_____________________________________________________________________________
_____________________________________________________________________________
If you use a mobility aid, please circle all that apply: *Restrictions may apply
Wheelchair* Long White Cane Knee Scooter
Service Animal Scooter* Walker
Are you using a mobility device that is not listed? If so please indicate. This will help us to serve you better.
Do you have a Personal Care Attendant? Y/N (If yes please provide his/her name).
______________________________________________________________________________
Personal Care Attendants are only permitted to ride with the registered user to and from his or her
destination.
By signing below I agree to the terms and conditions listed on the back.
Signature _________________________________________________ Date ________________
Access Card Assigned: _______________ Date Range____/____/____-_____/_____/_____
____________________________ ____________________________ ____________________
DSS REPRESENTATIVE/HR ADA DSS REPRESENTATIVE/HR ADA DATE
ADMINISTRATOR ADMINISTRATOR
PRINTED NAME SIGNED NAME
click to sign
signature
click to edit
Parking & Transportation Services 410-704-PARK
University Union Garage 410-704-RIDE
(f)410-704-8518
PARATRANSIT AGREEMENT
I understand that my application will be returned if it is not complete. I confirm that all of the information that I
provide on this application is true to the best of my knowledge. I understand that a false statement made herein
may result in the rejection of my application for Paratransit service. I also understand that failure to adhere to
the policies and procedures for using Paratransit may be grounds for suspending or revoking my eligibility to
participate in this program.
I understand and agree to the following:
I must call Parking & Transportations Services as soon as possible if there are any changes or
cancellations to my scheduled trips. Failure to do so will result in my trips being cancelled for the day.
Repeated failures to do so will result in the loss of riding privileges until I contact Parking &
Transportation Services or Disability Support Services.
I will schedule trips at least 30 minutes before my desired arrival time to account for weather, traffic and
other trips. I understand that other people are riding, too, so service may not be direct. During peak
times, I should schedule 45 minutes before my arrival time to be sure I arrive on time.
I should be at the pick-up location at least 5 minutes before my scheduled ride. The driver will not wait
past the scheduled time.
If I am not at the pick-up location I will be considered a No Show. All rides that day will be cancelled
unless I call Parking and Transportation Services.
I will contact Parking and Transportation Services if I no longer need the service before my permit
expires.
Failure to adhere to the policies and procedures for using Paratransit may be grounds for suspending or
revoking my eligibility to participate in this program.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Paratransitapplication10262017

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 1 December 2019

Message

View Audit Log
Print With Audit Log
Duplicate Document