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The form then gathers disability and mobility equipment information, including permanence, seizure history, mobility aids, and how disability affects use of Metro bus services. It includes bus-use capability questions, transfer and communication abilities, weather impact, training history, and current travel patterns with frequent destinations.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/ada-paratransit-eligibility-certification-form-revised-january-2024/306866/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/ada-paratransit-eligibility-certification-form-revised-january-2024/306866.png","ImageObject",442,249,{"name":88,"@type":89},"Terk","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",8,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What information must an applicant provide in Part I?","Question",{"text":109,"@type":110},"Applicants provide general identification and contact information such as name, ID number and expiration dates, and phone details, along with address information and demographic fields like gender preference and date of birth.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What disability and mobility details are requested in Part II?",{"text":114,"@type":110},"Part II asks how the disability affects using Metro bus services, whether the disability is permanent, seizure history and control, and which mobility aids are used (with options to check all that apply).",{"name":116,"@type":107,"acceptedAnswer":117},"What training and current travel information is collected in Parts IV and V?",{"text":118,"@type":110},"Part IV collects whether the applicant has received and completed bus-use training and whether they want training/retraining. 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Date    \nPID Exp. Date    \nPCA  yes  no  \nEligibility    \nConditional   \nUnconditional   \nComments    \n______________________________  \n______________________________  \n______________________________  \nRevised January 2024  \nMETRO RTA Paratransit Services  \n416 Kenmore Blvd. | Akron, Ohio | 44301 Phone: 330.762.0341 [yourmetrobus.org](yourmetrobus.org)  \nPART I: GENERAL INFORMATION TO BE COMPLETED BY APPLICANT (PLEASE PRINT OR TYPE)  \n\n| Last Name | First Name | Middle Initial |\n| --- | --- | --- |\n|  Male  Female |  Prefer Not to Say |  |\n|  |  | Date of Birth |\n\nStreet Address  \n\n| Building/Apt. \\# | Apartment Name |  |\n| --- | --- | --- |\n| City/Town | State | Zip |\n| Primary Phone Secondary Phone\u003Cbr>If you have a METRO ADA Paratransit ID Card, please provide the ID \\#: |  |  |\n| PART II: INFORMATION ON DISABILITY AND MOBILITY EQUIPMENT\u003Cbr>1. How does your disability prevent you from using METRO’s bus services? |  |  |\n\n\n|  |\n| --- |\n|  |\n|  |\n\n2. Is your disability permanent?  Yes  \n No  \nIf no, expected duration of your disability:   /  /  3. Have you ever had a seizure?  \n Yes  \n No  \nIf yes, what type?   How often?   Are your seizures controlled with medication?  \n Yes  \n No  \n4. Do you use any of the following mobility aids? (Check all that apply.)  Manual wheelchair  Cane  \n Powered wheelchair  Braces  \n Powered scooter  Service animal  \n Prosthesis  Personal care attendant  \n Walker  Other:  \n Crutches  \n_______________________  \n_______________________  \nPART III: QUESTIONS ON USING THE BUS  \n1. Have you ever used METRO’s bus services?  Yes  \n No  \n2. Have you participated in METRO’s reduced fare program? (i.e. older adults or those with disabilities)  \n Yes  \n No  \n3. Does your medical condition change from day-to-day, where it may be difficult to use bus services?  \n Yes, my physical condition is good on some days and bad on others  No, my physical condition does not change from day-to-day  \n Not sure  \n Other reasons    \n4. On days when your physical condition is good, can you, on your own or using a mobility aid:  \n Get to the curb in front of your house  \n Travel up to one (1) block  Travel up to four (4) blocks  Travel up to six (6) blocks  \n Can’t travel outside your house; please explain:  \n_____________________________________________________________________  \n5. On days when your physical condition is bad, can you, on your own or using a mobility aid:  \n Get to the curb in front of your house  \n Travel up to one (1) block  Travel up to four (4) blocks  Travel up to six (6) blocks  \n Can’t travel outside your house; please explain:  \n_____________________________________________________________________  \n6. Does the weather have an effect on your ability to use bus services?  Yes  \n No  \n I don’t know  \nIf yes, how does the weather affect your ability to use bus services?  \n_____________________________________________________________________  \n_____________________________________________________________________  \n7. Are you currently using METRO’s bus services?  Yes  \n No  \nIf yes, what routes?   8. Can you transfer from one bus to another?  \n Yes  \n No, please explain:    \n_____________________________________________________________________  \n9. Are you able to, on your own, use the telephone to obtain bus information?  \n Yes  \n No, please explain:    \n_____________________________________________________________________  \n10. Are you able to follow written or oral instructions to use bus services?  Yes  \n No, please explain:    \n_____________________________________________________________________  \n11. Can you, without the assistance of another person, get to or from the bus stop nearest your home?  \n Yes  Not sure  \n No, please explain:    \n_____________________________________________________________________  \n12. Can you wait ten (10) minutes at a bus stop that has a seat and a shelter?  \n Yes  Not sure  \n No","cbCain3xY4MS4aCO","https://ap.wps.com/l/cbCain3xY4MS4aCO","pdf",3077840,"English","# PART I: GENERAL INFORMATION TO BE COMPLETED BY APPLICANT (PLEASE PRINT OR TYPE)\n# PART II: INFORMATION ON DISABILITY AND MOBILITY EQUIPMENT\n## 1. How does your disability prevent you from using METRO’s bus services?\n## 2. Is your disability permanent?\n## 3. Have you ever had a seizure?\n## 4. Do you use any of the following mobility aids? (Check all that apply.)\n# PART III: QUESTIONS ON USING THE BUS\n## 1. Have you ever used METRO’s bus services?\n## 2. Have you participated in METRO’s reduced fare program?\n## 3. Does your medical condition change from day-to-day?\n## 4. Travel limits on good days and explanations\n## 5. Travel limits on bad days and explanations\n## 6. Weather impact on bus service ability\n## 7. Current use of METRO bus services and routes\n## 8. Ability to transfer between buses\n## 9. Ability to obtain bus information by telephone\n## 10. Ability to follow written or oral instructions\n## 11. Ability to reach the nearest bus stop\n## 12. Ability to wait 10 minutes at a sheltered stop\n## 13. Ability to wait 10 minutes at an unsheltered stop\n## 14. Ability to board/exit with a mobility lift\n## 15. Ability to pay bus fare with written/oral instructions\n## 16. Ability to recognize when to get on and off\n# PART IV: QUESTIONS ABOUT TRAINING\n## 1. Have you ever received training on how to use a bus?\n## 2. Did you complete the training?\n## 3. Would you be interested in receiving training/retraining?\n# PART V: YOUR CURRENT TRAVEL","[{\"question\":\"What information must an applicant provide in Part I?\",\"answer\":\"Applicants provide general identification and contact information such as name, ID number and expiration dates, and phone details, along with address information and demographic fields like gender preference and date of birth.\"},{\"question\":\"What disability and mobility details are requested in Part II?\",\"answer\":\"Part II asks how the disability affects using Metro bus services, whether the disability is permanent, seizure history and control, and which mobility aids are used (with options to check all that apply).\"},{\"question\":\"What training and current travel information is collected in Parts IV and V?\",\"answer\":\"Part IV collects whether the applicant has received and completed bus-use training and whether they want training/retraining. Part V asks the applicant to list their most frequent destinations and describe how they travel to them now.\"}]","ADA Paratransit Eligibility Certification Form - Revised January 2024 | PDF",1789841984]