Transportation Acknowledgement Form

Goodwill: Industries of Wayne and Holmes Counties, Inc.

Appointments During Program Hours:

During program hours (8a.m.-2:30p.m, Goodwill transportation will drop you off and pick you up from approved appointments. You may not self-transport to appointments during program hours. Appointments must be arranged with your case manager 24 hour prior to the appointment.

Good will transportation is for Wooster City Limits only. Transportation outside of Wooster must be approved by the Mission Services Director. This includes Goodwill transportation as well as alternate methods of transportation. The last appointment to use Goodwill transportation home is 1:00p.m. If your appointment is after 1:00p.m., you must find your own way home. You are to report for transportation at your scheduled departure time. If you are late reporting to transportation, you will not be transported to your appointment that day. Once dropped off at your appointment, you must wait one hour from your appointment time for transportation to come back to pick you up.

If your appointment is going to be longer than one hour, call the number provided to let transportation know you will be late.

Client Signature*

Client Name*

Date*

Date

Select the method that was used to complete form*

Case Manager Name*

Title*

Date*

Date