Dial-A-Ride Paratransit Services Application

Dial-a-Ride Application Form (42k PDF)

If you have a disability or condition which prevents you from using a lift or ramp equipped bus some or all of the time, you may be eligible for Yakima Transit’s Dial-A-Ride Paratransit Service some or all of the time. Age or the inability to drive are not considered qualifying factors.

TO APPLY:
• Fill out the enclosed application form or have someone fill it out for you.
• Have Part 4 (Professional Verification) completed and signed by a licensed medical or mental health professional knowledgeable of your abilities or conditions.
• Sign the application, along with the Applicant Agreement and Release of Information
• Return the completed application form.
• Yakima Transit will process your application and notify you within 21 days after the completed application arrives in our office.
• This form has 8 pages. Please be sure that all sections have been completed.

Mail completed application form to:
Yakima Transit
Dial-A-Ride Paratransit Service
2301 Fruitvale Blvd.
Yakima, WA 98902

If you have any questions or need assistance in completing this application, call 575-6054, or TTY 575-6008. The information you provide will be used to make a decision about your eligibility for Dial-A-Ride Paratransit Services. It is important that all parts of this application are completed. Incomplete information may delay processing of your application.

Alternate formats of this document will be provided upon request.

 

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