Paratransit Application Forms

The following two forms are required in order to request Paratransit services.  Both applications can be filled out online and then printed for submission. In order to digitally fill out an application, please download and fill out in a PDF editor.

Quick Request for Approved Paratransit Riders

Things You Should Know: Trip requests must be in no later than 5PM the business day before the day of the trip. (Note we are closed on Sunday) If you experience any difficulties using this service please call us @(434)455-5099 or fax us @ (434)847-8621 with your trip details.

*Riders must fill out the Paratransit Eligibility Application forms and be approved before filling out the following Paratransit Trip Request. Failure to do so will result in a denied trip request. 

Paratransit Trip Request

  • Myself
  • Myself and a Personal Aide
  • Month
  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December
  • Day
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
  • Year
  • 2018
  • 2019
  • 2020
  • 2021
:
  • Period
  • AM
  • PM
:
  • Period
  • AM
  • PM
  • Yes, I will need a ride back where I came from
  • Yes, I need a ride to a secondary location
  • No, I do not need a return trip
:
  • Period
  • AM
  • PM

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