Palm tran connection application 2026

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The document is a Paratransit Eligibility Application for Palm Tran CONNECTION, detailing the process for individuals to apply for transportation services due to disabilities or income limitations. It includes instructions on completing various parts of the application, which assess eligibility for different programs under the Americans with Disabilities Act (ADA) and Transportation Disadvantaged Program. The application requires personal information, verification of disability and income, and provides guidelines on confidentiality and processing times.

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Click ‘Get Form’ to open the palm tran connection application in the editor.
Begin with Part 1: General Rider Information. Fill in your last name, first name, middle initial, and address details. Ensure all fields are completed accurately.
Indicate any mobility aids you use by checking the appropriate boxes. This information is crucial for determining your eligibility.
In Part 2, sign and date the Applicant Certification section. If someone assisted you, provide their contact information as well.
Proceed to Part 3 for Verification of Income. Enter your total monthly income and attach necessary proof of income documents.
Finally, complete Part 4 regarding Verification of Disability. Answer all questions thoroughly to ensure accurate assessment of your needs.

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