TRIP-LINK APPLICATION

The information obtained in this application will be used to determine eligibility for the Transportation Reimbursement Intercommunity Program (TRIP-LINK) and will not be provided to any other person or agency without prior written approval of the applicant.

 

The “Applicant’” must fully complete the application form.

The “Applicant’s” Legal Representative or Guardian may complete for the “Applicant.”

Your detailed responses and explanations will help us to determine if you are eligible for the program. Please respond to ALL questions or your application will be considered incomplete. 

 

Applicant may be required to send other documents that will help us understand abilities. All information provided will be kept strictly confidential.

The TRIP-LINK eligibility specialist will be contacting you for any needed additional information after you have submitted this portion of the application. We will not determine your eligibility until we have received any additional information that we request from you. This portion of your application is the first step of applying. Please make sure to provide accurate contact information so that we can follow up with you to obtain any other needed information.

APPLICANT NAME

Name of person completing this application if other than Applicant, put NA if not applicable: