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Americans with Disabilities Act (ADA) Application Form for Paratransit (Jaunt)

  1. 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 fi t 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. *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.*

  7. Is your condition temporary?

    If "yes", on what date will your disability no longer prevent you from using CAT bus routes?

  8. Do you use any of these mobility aids?

    Check all that apply:

  9. Can you climb three 12-inch steps without assistance?

  10. What is the farthest distance you can travel without the help of another person?

  11. For example, do steep hills, lack of sidewalks, or other local conditions affect your mobility? Please explain.

  12. Is your ability to travel outdoors severely affected by weather, such as:

  13. Snow and Ice

  14. Extremely hot temperature

  15. Extremely cold temperature

  16. Other weather condition

  17. Do you use a personal care attendant (PCA) when you travel?

  18. Is the PCA paid for these services?

  19. CAT provides a travel training program that teaches persons with disabilities how to use CAT bus routes. Would you like to receive travel training?

  20. Please be specific, list street addresses, and/or names of businesses.

  21. Print and Sign

    Print and Sign this form. You can mail or deliver this form using the addresses below:

  22. In Person

    Charlottesville Area Transit: Downtown Transit Station, 615 East Water Street, Charlottesville, VA 22902

  23. By Mail

    Charlottesville Area Transit, 1545 Avon Street Extended, Charlottesville, VA 22902

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