Get the free Application Web - Valley Transit

—For Office Use Only ID# PCA Temporary Permanent Date Application for Reduced Fare Permit For Senior and Disabled Persons (this application is available in accessible format) Please Print Name Address

I have a health condition that will permit me to remain seated on the bus for more than 45 minutes. I am less than 18 years of age and am less than 4 feet 9 inches in height. Furthermore, I am blind or have low vision. Furthermore, I am deaf and cannot hold a pen or telephone. Furthermore, I am visually impaired (I am unable to read in any visual area). Furthermore, I am physically invalid. Furthermore, I am temporarily deaf or temporarily blind or visually impaired. Furthermore, I am physically disabled. Furthermore, I am a permanent employee of the U.S. Government. Furthermore, I am a veteran, or I am a member of the Armed Forces of the United States. Furthermore, I have a valid Military Passport with original and a photocopy. Furthermore, I hold a valid State I.D. (Driver's License, State ID Card, Military ID, etc.) I am a U.S. citizen. Furthermore, I have at least 1 year in the past to prove my address is current. Furthermore, I have a valid Public Ferry Pass. Furthermore, I hold a valid City Pass. Furthermore, I have a valid state issued Pass. Furthermore, I am a resident of an area served with Metro Transit Service and currently live less than 1 mile from the bus stop I am a resident of the North Side. My residential address does not change before 10 pm (i.e. a person living in the South Side has their residential address moved to the North Side as they are no longer residents of the South Side). I have an alternate transportation arrangement with a local provider. I have a valid Public Vehicle Permit or a permit that requires an applicant's signature (i.e. a parking permit, permit parking, commercial driver, parking station-based or park-and-ride permit, and permit to park a vehicle with a tow truck). Furthermore, I have a valid Disabled Person's Pass. Furthermore, I am a student currently attending college. Furthermore, I am a person who is receiving Social Security or Medicare or disability payments, or who is otherwise certified to receive social security, medicare or other government payments. Furthermore, I am a pregnant woman. Furthermore, I have an authorized caregiver, and I am receiving child care services related to receiving medical care. Furthermore, I am a veteran of the U.S. armed forces. Furthermore, I am a veteran, or I am the spouse of a veteran. Furthermore, I am a person who is receiving special federal, state or local assistance such as unemployment insurance or public assistance benefits, or a food stamp benefits. Furthermore, I am a parent. Furthermore, I have a Social Security Card. Furthermore, I am a person who is receiving Social Security. Furthermore, I have a disability.

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