Fixed Route Reduce Fare Program APPLICATION Applicant: Fill out the information on page one (1). Information must be complete, accurate and legible. When you have completed page one (1), please have a licensed physician or psychiatrist complete the remainder of the application. If you have any questions about your application, call (937) 425-8444 or Ohio Relay 711. Physician/Psychiatrist: Complete pages two and three (2-3). Information must be complete, accurate and legible. When application is complete, please mail to: RTA Certification Center: 4th S. Main Street, 2nd Floor Dayton, Ohio 45402 (937) 425-8444 Ohio Relay 711 –or– General Information: The Eligibility Criteria of the application assist Greater Dayton Regional Transit Authority determine if the applicant may be eligible for the Fixed Route Reduced Fare Program. Reduced Fare Identification Cards for persons with a permanent disability are valid for a five (5) year period. Identification Cards for persons with a temporary disability are valid until the expiration date provided by physician. Eligibility for a Reduced Fare Identification Card is based on the or applicant’s physical mental disability, or an impairment that limits one or more major life functions as defined by the Americans with Disabilities Act (49 CFR Part 37). Any fees charged for the completion of the application are not the responsibility of Greater Dayton Regional Transit Authority. Information on the application is confidential. Exclusions: Persons whose sole incapacity is any reasons listed below they are excluded from Reduced Fare eligibility. Pregnancy Obesity Contagious disease Acute or chronic alcoholism or drug addiction
Fixed Route Reduce Fare Program APPLICATION Applicant: Fill out the information on page one (1). Information must be complete, accurate and legible. When you have completed page one (1), please have a licensed physician or psychiatrist complete the remainder of the application. If you have any questions about your application, call (937) 425-8444 or Ohio Relay 711. Physician/Psychiatrist: Complete pages two and three (2-3). Information must be complete, accurate and legible. When application is complete, please mail to: RTA Certification Center: 4th S. Main Street, 2nd Floor Dayton, Ohio 45402 (937) 425-8444 –or– Ohio Relay 711 General Information: The Eligibility Criteria of the application assist Greater Dayton Regional Transit Authority determine if the applicant may be eligible for the Fixed Route Reduced Fare Program. Reduced Fare Identification Cards for persons with a permanent disability are valid for a five (5) year period. Identification Cards for persons with a temporary disability are valid until the expiration date provided by physician. Eligibility for a Reduced Fare Identification Card is based on the applicant’s physical or mental disability, or an impairment that limits one or more major life functions as defined by the Americans with Disabilities Act (49 CFR Part 37). Any fees charged for the completion of the application are not the responsibility of Greater Dayton Regional Transit Authority. Information on the application is confidential. Exclusions: Persons whose sole incapacity is any reasons listed below they are excluded from Reduced Fare eligibility. Pregnancy Obesity Contagious disease Acute or chronic alcoholism or drug addiction
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