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Check all that apply:
*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.*
Please be specific, list street addresses, and/or names of businesses.
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:
CAT ADADowntown Transit Station615 E Water StCharlottesville, VA 22902
* indicates a required field