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Charlottesville Area Transit Application for ADA Paratransit (Revised March 2022)

  1. Americans with Disabilities Act (ADA) Paratransit Eligibility Standards:
  2. • Any individual with a disability who is unable, as a result of a physical or mental impairment (including vision impairment), and without the assistance of another individual (except the operator of a wheelchair lift or other boarding assistance device), to board, ride, or disembark from any vehicle on the system which is readily accessible to and usable by individuals with disabilities.
  3. • Any individual with a disability who has a specific impairment-related condition which prevents such individual from traveling to a boarding location or from a disembarking location on such system.
  4. After reviewing the above information, if you feel that your disability may fit into one of the above mentioned categories, please complete the Paratransit Application in full.
  5. If you do not meet the above criteria, have questions or comments about paratransit service, or need this application in an accessible format, please contact Customer Service at 434-970-3649 (Option 2).
  6. Do you use any of these mobility aids?

    Check all that apply:

  7. Please explain.

  8. Is your condition temporary?
    If "yes", on what date will your disability no longer prevent you from using CAT bus routes?
  9. *Sometimes, CAT may ask an applicant to provide additional information regarding a disability in order to determine that applicant's eligibility to use paratransit service.*

  10. Can you climb three 12-inch steps without assistance?
  11. What is the farthest distance you can travel without the help of another person?
  12. For example, do steep hills, lack of sidewalks, or other local conditions affect your mobility? Please explain.
  13. Is your ability to travel outdoors severely affected by weather, such as:
  14. Snow and Ice
  15. Extremely hot temperature
  16. Extremely cold temperature
  17. Other weather condition
  18. Do you use a personal care attendant (PCA) when you travel?
  19. Is the PCA paid for these services?
  20. CAT provides a travel training program that teaches persons with disabilities how to use CAT bus routes. Would you like to receive travel training?
  21. Please be specific, list street addresses, and/or names of businesses.

  22. Print, Sign, and Date

    Print, sign, and date this form. If the applicant is unable to sign, a representative may do so in their place. This form must be mailed or delivered (with an original signature) to the address below:

  23. Print Name
  24. Signature
  25. Date
  26. Address

    CAT ADA
    Downtown Transit Station
    615 E Water St
    Charlottesville, VA 22902

  27. Leave This Blank: