Transit Service

Elderly or Disabled Fare Assistance Application

Instructions:

Fill out Form
Attach Proof of Age or Proof of Disability
Click “Submit”

SECTION I Form

Name

Address

City

State

Zip Code

Phone Number

Date of Birth

Age

Disabled

Yes

Please indicate any special transportation needs:

Wheelchair lift needed
Service animal will be accompanying me
Personal Care Assistant (PCA) will be accompanying me

Section II Attach Proof of Age or Disability

If you qualify based on age (65 or older)…

Attach one of the following types of documentation proving age such as:

Copy of driver’s license
State ID
Military ID
Birth Certificate
Passport
Letter from Social Security verifying birth date

ATTACH PROOF OF AGE

If you qualify based on disability…

Attach one of the following types of documentation proving disability such as:

Physician’s Letter of Verification stating client is disabled
SSI (Supplemental Security Income) Award Letter stating client is disabled
Veteran’s Award Letter stating client is disabled
Workman’s Compensation Award Letter stating client is disabled
Social Security Award Letter stating client is disabled

Documentation must state the applicant is disabled, as per the definition of disability in the Americans with Disabilities Act. An Income Statement does not qualify.

ATTACH PROOF OF DISABILITY

Section III Submit Form

Additional Information

Please allow two weeks to process form. An ID card will be mailed to you within one month.

If you prefer, applications and documentation may be sent via fax, email or mail.

Fax: 513-695-2980
Email: wctransit@co.warren.oh.us
Mail: Warren County Grants Administration
406 Justice Drive
Lebanon, OH 45036

Questions? Call us at 513-695-1259

To schedule a ride, call 1-888-297-0990.