Ride Calhoun Application for ADA Certification / Paratransit Services

  • Ride Calhoun Application for ADA Certification / Paratransit Services

  • The Transportation Authority of Calhoun County (TACC) / Ride Calhoun provides public transportation services on our fixed route buses, and door-to-door transportation within our fixed route service area through the use of RC MOVE paratransit service.  RC MOVE services are for persons who are certified as being ADA paratransit eligible. In order to participate in this program, you must complete this application and the Medical Release of Information form in full. 

    Ride Calhoun will evaluate the information provided in the application. In order to evaluate your request, it may be necessary to contact a physician or other professional to confirm the information you have provided. You must print, fill out, and sign the Medical Release of Information form and return it to the Ride Calhoun office for your application to be complete.  Medical Release of Information forms can be delivered to:  Ride Calhoun, 339 W. Michigan Ave., Battle Creek, MI 49017.   You will be informed of your approval or denial within 21 days of receipt of the completed application AND Medical Release of Information.  If your application is approved, you will be given information on how to get your identification card and use the RC MOVE service.  If your application is denied, you will be given information on how to appeal the determination.  

     
    TACC/Ride Calhoun reserves the right to verify the information reported on this application by contacting persons completing the forms.  Application forms are confidential records and kept on file at the Ride Calhoun administrative office.  If you have any questions regarding this application, please call Ride Calhoun at (269) 966-3474. Should you be certified as permanently eligible, you will be issued a PERMANENT identification card and no additional application or certification will be required.   
     
    Should you be certified as temporarily eligible, you will be issued a TEMPORARY identification card. Temporary identification cards may be renewed if the disabiling condition exists beyond the expiration date of the orignial card.  You may be required to submit a new application. 

     

    RIDE CALHOUN IS COMMITTED TO PROVIDING A FULLY ACCESSIBLE EXPERIENCE. IF YOU REQUIRE THIS INFORMATION IN A DIFFERENT FORMAT, PLEASE CONTACT US AT (269)966-3474.

     

     

     

  • Date of Birth:*
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  • Is this condition temporary or permanent? *
  • If your condition is temporary, please indicate the estimated duration date.
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  • Do you use any of the fololowing aids to mobility (check all that apply)?:*
  • Can you travel 200 feet without the assistance of another person?*
  • Can you travel 1/4 mile without the assistance of another person?*
  • Can you travel 3/4 mile without the assisstance of another person?*
  • Can you climb three 12-inch steps without assistance?*
  • Can you wait outside without support for 10 minutes?*
  • Is your ability to travel outdoors affect by snow or ice?*

  • By typing your name and date below you certify that the information provided in this form is correct.

  • *
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  • Should be Empty: