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How do I fill this out?
To fill out the ADA Eligibility Application, start by providing your personal information, including your contact details. Next, answer questions related to your disability and how it affects your ability to use public transit services. Ensure all sections are completed accurately before submitting.

How to fill out the East Bay Paratransit ADA Eligibility Application?
1
Gather personal and contact information.
2
Describe your disability and its impact on transit use.
3
Provide information about your capabilities and mobility aids.
4
Check all applicable boxes regarding your living situation.
5
Review the form for completeness before submission.
Who needs the East Bay Paratransit ADA Eligibility Application?
1
Individuals with disabilities who require transportation assistance.
2
Caregivers who assist disabled individuals in accessing transit services.
3
Seniors who experience mobility challenges and need accessible transport.
4
Healthcare providers who assist clients in obtaining necessary transit information.
5
Social service workers aiding clients with disability claims and transportation.
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What are the instructions for submitting this form?
To submit this form, send the completed application via fax to (510) 287-5069 or email it to the designated address provided within the document. Alternatively, you can mail the application to 1750 Broadway, Oakland, CA 94612. It is advisable to keep a copy of the finished application for your records.
What are the important dates for this form in 2024 and 2025?
The submission deadlines for the East Bay Paratransit ADA Eligibility Application are established yearly. For 2024, please submit all applications by June 30. Important updates may arise in 2025; check for any changes to submission requirements.

What is the purpose of this form?
This form is essential for individuals seeking eligibility for paratransit services offered by East Bay. It collects critical information related to the individual's disability, addressing their specific needs regarding transportation. By filling out this form, applicants ensure they receive appropriate assistance and services tailored to their requirements.

Tell me about this form and its components and fields line-by-line.

- 1. Name: Complete the name section with your first, middle, and last names.
- 2. Contact Information: Provide your daytime, evening, and cell phone numbers.
- 3. Birth Date: Enter your date of birth.
- 4. Gender: Indicate your gender by selecting Female or Male.
- 5. Primary Language: Specify your primary language, including English and other options.
- 6. Home Address: Include your residential address with city, state, and zip code.
- 7. Mailing Address: If different from your home address, provide your mailing address.
- 8. Emergency Contact: List an emergency contact's name, relationship, and phone number.
- 9. Disability Description: Detail your disability and how it limits transit use.
- 10. Mobility Aids: Check any mobility aids or specialized equipment you use.
- 11. Living Situation: Describe your living arrangement and independence.
- 12. City Blocks: Estimate how far you can travel with your mobility aid.
- 13. Waiting Capacity: Provide details regarding your ability to wait for a ride.
- 14. Transit Experience: Share your history with AC Transit and BART services.
What happens if I fail to submit this form?
Failure to submit this form may result in delayed access to necessary transportation services. Applicants could miss out on essential assistance tailored for their needs. It's crucial to ensure all sections are filled out correctly for smooth processing.
- Delayed Services: A failure to submit may lead to interruptions in receiving necessary transportation assistance.
- Complications in Approval: Incomplete applications may complicate or prolong the approval process.
- Inaccessible Transportation: Without proper submission, individuals may face difficulties in accessing public transit services.
How do I know when to use this form?

- 1. Paratransit Services: Individuals who need specialized transportation options due to mobility impairments.
- 2. Access to Public Transit: Applicants who require additional support when using standard public transit.
- 3. Assistance for Seniors: Elderly individuals needing enhancements to travel independently.
- 4. Social Services Coordination: Support staff coordinating services for disabled clients.
- 5. Healthcare Services: Healthcare providers assisting patients in accessing needed transport.
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