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Fill Out Your Metro Mobility Application Form

The Metro Mobility Application form is a crucial document designed for individuals seeking eligibility for paratransit services under the Americans with Disabilities Act (ADA). This form consists of two parts: the Certification Questionnaire and the Professional Verification Form, both of which must be completed in full. To begin the process of securing essential transportation assistance, please fill out the application by clicking the button below.

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Article Structure

The Metro Mobility Application form is an essential document for those seeking paratransit services under the Americans with Disabilities Act (ADA). To ensure a smooth application process, applicants must complete and submit two key forms: the Certification Questionnaire and the Professional Verification Form. The first step involves filling out the Certification Questionnaire, which requires detailed information from the applicant or their advocate. Accuracy is crucial, and signatures are needed from both the applicant and their guardian, if applicable. The Professional Verification Form must then be filled out by a qualified professional—such as a physician, psychologist, or therapist—who can attest to the applicant's condition. This form also requires a signed authorization for information release. Once both forms are completed, they should be sent together to the Metro Mobility Service Center, as submissions via fax or email are not permitted. In certain cases, an in-person assessment may be necessary for additional clarity. It's vital to avoid common pitfalls, such as missing signatures or incomplete forms, to prevent delays in the eligibility determination. Addressing these areas with care can help facilitate access to necessary transportation services.

Metro Mobility Application Example

APPLICATION INSTRUCTIONS

All applicants must submit a complete application which includes BOTH FORMS

(1)The Certiication Questionnaire Form

(2)The Professional Veriication Form

STEP 1 COMPLETE THE CERTIFICATION QUESTIONNAIRE

The Certiication Questionnaire should be illed out by

the applicant or the applicant’s advocate. The form must be illed out in its entirety. It should be signed by the applicant or the applicant’s guardian and anyone who assisted the applicant in completing the application.

CERTIFICATION

QUESTIONNAIRE

Americans with Disabilities Act (ADA) | Paratransit Eligibility

1.	See application Instructions	We do not
2.	If you have additional questions call Metro Mobility	accePt
	Customer Service at (651) 602-1111 voice, (651) 221-9886 TTY.	aPPlications
3. This form is incomplete if it is NOT ACCOMPANIED BY COMPLETED		by fax
	PROFESSIONAL VERIFICATION.

This application and future written information are available in large print. Does large print better suit your needs?

PART 1 APPLICANT DATAPlease Print or tyPe

Name: ______________________________________________________________________________________

STEP 2 COMPLETE THE PROFESSIONAL VERIFICATION FORM

The Professional Veriication Form must be completed by one of the following professionals who are familiar with the applicant’s condition:

•Physicians or Psychiatrists

•Occupational Therapists

•Psychologists

•Physical Therapists

•Licensed Independent Social Workers (LISW, LICSW)

•Recreational Therapists

•Speech/Language Pathologists

•Certiied Orientation and Mobility Specialists

•Registered Nurses (RN)

•Doctors of Chiropractic (DC)

ELIGIBILITY APPLICATION

PROFESSIONAL VERIFICATION

Americans with Disabilities Act (ADA)

1.	Complete and sign the “Authorization to Release Information”.	We do not
2.	Send to your designated professional.	accePt
3.	Wait for the professional to return this form to you.	aPPlications
	Check back with your professional if you don’t receive your information.	by fax

4.This form is incomplete if it is NOT ACCOMPANIED BY COMPLETED CERTIFICATION QUESTIONNAIRE.

SECTION A RELEASE INFORMATION		Please Print or tyPe
AUTHORIZATION TO


(WHEN COMPLETE SEND TO THE PROFESSIONAL YOU NAMED)
Applicant’s Name: First	Middle Initial	Last
Birth Date:______/______/______

Applicant’s Address: ________________________________________________ Apt.#:____________________

City: ___________________________________________ State:_____________ Zip Code: ________________

Applicant’s Telephone Number (

) ______________________________

I authorize the following professional to release to the MMSC speciic information as requested. It is my understanding that the information released will be used solely to determine my ADA paratransit eligibility. I understand that I may revoke this authorization at any time. Unless revoked, this form will allow that professional listed below to release information described for six months after the date appearing below.

Name of Professional: _______________________________________________ Title:_____________________

Applicant’s Signature: ____________________________________________ Date: ______/______/______

Guardian’s signature required if the applicant is not his/her own guardian,

Guardian’s Signature:_____________________________________________ Date: ______/______/______

To complete the Professional Veriication Form

1.Complete and sign the Authorization to Release Information.

2.Send the Professional Veriication Form to your designated professional.

3.Wait for your professional to return the Professional Veriication Form to you. Check back with your professional if you have not received the form back in a timely manner.

STEP 3 SUBMIT BOTH FORMS TOGETHER

Submit both the Certiication Questionnaire and the Professional Veriication Form in the same envelope to

Metro Mobility Service Center

390 N. Robert Street

Saint Paul, MN 55101-1805

WE DO NOT ACCEPT APPLICATIONS BY FAX OR E-MAIL	See additional info on back

STEP 4 IN-PERSON ASSESSMENT

Usually the forms provide Metro Mobility Staff with all of the information needed to make a determination on eligibility. Sometimes however more information is needed. When this happens an applicant may be asked to come in for an “in-person assessment.”

This assessment may include:

•A conversation about the applicant’s current mobility. The Metro Mobility evaluator will talk with you about how you currently get around.

•A pretend bus trip on the computer. This standardized test is designed to measure a person’s cognitive ability to use regular ixed-route transit. (Functional Assessment of Cognitive Transit Skills or FACTS for short.)

•A walk outside or through the skyway. This will help determine things such as physical ability to get to the regular ixed-route bus as well as memory and landmark recognition.

•A standard walking and balance test. This standardized test measures a person’s risk of falling. (Tinetti Gait and Balance Test.)

PLEASE NOTE THAT APPLICANTS WHO NEED TO COME IN FOR IN-PERSON ASSESSMENTS WILL STILL HAVE THEIR APPLICATIONS PROCESSED WITHIN 21 CALENDAR DAYS.

COMMON ISSUES

In order to make a determination within 21 calendar days the Metro Mobility Service Center must have a complete application. There are several things which may cause an application to be incomplete. By double checking these things PRIOR to submitting your application you may avoid delays in processing.

1.One of the forms is missing. Your application must contain both the Certiication Questionnaire and the Professional Veriication. Please ensure both are submitted in the same envelope.

2.One of the forms is not signed. Both the Certiication Questionnaire and the Professional Veriication must be signed. If either the applicant or the professional forgets to sign the form it is considered incomplete.

3.The professional credentials are missing. Professionals must include their titles and credentials when signing the Professional Veriication.

Jane Doe X (Incomplete) Jane Doe M.D.

(Complete) Jane Doe R.N.

(Complete)

AN INCOMPLETE APPLICATION WILL BE RETURNED TO THE APPLICANT ONE (1) TIME. IF IT IS SUBMITTED A SECOND TIME AND IS STILL INCOMPLETE IT WILL BE HELD FOR 60 DAYS BY THE METRO MOBILITY SERVICE CENTER BEFOREIT IS DISCARDED.

APPLICATIONS MUST BE PROCESSED WITHIN 21 CALENDAR DAYS. IF YOUR PROPERLY COMPLETED AND SUBMITTED APPLICATION IS NOT PROCESSED WITHIN 21 DAYS, YOU WILL BE GRANTED PRESUMPTIVE ELIGIBILITY FOR METRO MOBILITY SERVICE UNTIL YOUR APPLICATION IS PROCESSED.

Questions? Please call 651-602-1111

CERTIFICATION

QUESTIONNAIRE

Americans with Disabilities Act (ADA) | Paratransit Eligibility

1.See application Instructions

2.If you have additional questions call Metro Mobility

Customer Service at (651) 602-1111 voice, (651) 221-9886 TTY.

3.This form is incomplete if it is NOT ACCOMPANIED BY COMPLETED PROFESSIONAL VERIFICATION.

WE DO NOT ACCEPT APPLICATIONS BY FAX

This application and future written information are available in large print. Does large print better suit your needs?

PART 1 APPLICANT DATA

PLEASE PRINT OR TYPE

Name: ______________________________________________________________________________________

FirstMiddle InitialLast

Street Address: ____________________________________________________ Apt.#:____________________

City: ______________________________________________________________ Zip Code: ________________

Day Telephone: (	) ________________________ Evening Telephone: (	) ________________
Email Address: _____________________________________________________
I prefer communication via email: ____Yes ____No
Birth Date:______/______/______
Do you have a Minnesota state ID card or Minnesota driver’s license?		Yes	No

ID # ______________________________ License # ______________________ Expiration Year: __________

Mailing Address (if different from above)

Street Address: ____________________________________________________ Apt.#: __________________

City: ______________________________________________________________ Zip Code: ______________

Emergency Contact Person

Name: _____________________________________________________________________________________

First	Middle Initial	Last
Day Telephone: (	) _______________________ Evening Telephone: (	) _______________

1.Are you able to travel in an automobile? ____Yes ____No

2.If you use a wheelchair or scooter:

Is it more than 30 inches wide? ____Yes ____No

Is it more than 48 inches long? ____Yes ____No

Is the combined weight of device and occupant more than 600 pounds? ____Yes ____No

3. Which of the following assistive devices, if any, do you use? (Please check all that apply.)

Cane	Manual Wheelchair	Boarding Chair	Prosthesis
White Cane	Powered Wheelchair	Service Animal	Communication Aid
Walker	Powered Scooter/	Portable Oxygen	Other (please describe):
Crutches	Cart	Transfer Board

If you selected Wheelchair or Scooter, would you prefer/need to use the device while riding in Metro Mobility Vehicles? ____Yes ____No ____Sometimes

4.Does your health condition/disability require you to use Metro Mobility service:

Seasonally (Nov. - Apr.)

Permanently	Temporarily
If temporarily, for how long?	Week(s)	Month(s)

5.Does your health condition/disability change from day to day in ways that occasionally disrupts your ability to use regular-route city bus service? ____Yes ____No

If yes, please explain: ______________________________________________________________________

6.When using Metro Mobility service, does your health condition/disability require you to travel with someone to assist and/or supervise you? ____Yes ____No

PART 2 QUESTIONS ABOUT USING

REGULAR-ROUTE PUBLIC TRANSIT

Complete Part 2 even if you are unable to use regular-route city bus service. This information will assist us in determining how your disability/health condition affects your ability to use regular-route city bus

service.

7. Do you now independently use regular-route city buses? ____Yes ____No ____Sometimes

If “Yes” or “Sometimes,” how many times?

per week

per month per year

Which of the following best describes how you use regular-route city buses?

To travel to and from one destination only

To travel to and from a few destinations

To travel to and from many different destinations

Explain what prevents you from independently using regular-route city bus.

8. Have you ever had training to use the regular-route city buses? ____Yes ____No

9. Using a mobility aid or on your own, how far are you able to travel without the assistance of

another person?	3 blocks	6 blocks
	9 blocks or more	less than 3 blocks

10.I can wait for a regular-route city bus (check all that apply):

Only if there is a bench or shelter

Up to 15 minutes

More than 15 minutes

11.Please check all the categories below as they relate to your ability to use regular-route city buses:

	I am:	Yes	No	Sometimes
A.	Able to tolerate very hot or very cold weather
B.	Able to recognize destinations, bus stops, or landmarks
C.	Able to tolerate air pollution (smog, fumes, perfume)
D.	Free from night blindness
E.	Able to recognize printed information
F.	Able	to hear and process spoken words or auditory information
G.	Able to communicate needs
H.	Able to follow directions

I.Able to deal with unexpected situations or changes in routine

(example: bus detours)...................................................................

J.Able to safely and effectively travel through crowded and/or

complex facilities............................................................................

K. Able to recognize changes in terrain..................................................

L.Able to travel independently along sidewalks and other

pedestrian ways ..............................................................................

M. Able to cross streets independently...................................................

N. Able to ind the correct bus stop .......................................................

O. Able to identify the correct bus..........................................................

P. Able to get on and off a bus using the lift if necessary......................

Q. Able to deposit fare into the fare box or show bus pass ...................

R.Able to get to a seat/wheelchair position and remain seated

during a bus trip ..............................................................................

S. Familiar with what to do if I miss my bus...........................................

If you checked “No” or “Sometimes” to any of the items in question 11, please explain:

More Space Provided On The Next Page

PART 3 APPLICANT SIGNATURE

The information provided on this form is private data and is used to determine ADA paratransit eligibility. The ability to determine your eligibility is based on receiving all of the information requested on this form. All medical or locational information pertaining to application for or users of ADA paratransit service is private. Any other information cannot be released to anyone else, unless the applicant or user authorizes the release in writing. If you are determined ADA paratransit eligible, information about your eligibility status will be entered into a database maintained by the Minnesota Department of Public Safety, Driver and Vehicle Services Division. This information could be used by Drivers License Division of the Depart- ment of Public Safety to (1) Reexamine your driving ability or, (2) Demand that you surrender your license if a severe disabling condition has developed since the current license was issued.

I certify that all information on this application form is accurate. I understand that misinformation or misrepresentation of facts will be cause for disqualiication or rejection of my ADA eligibility. I also understand that additional information relating to my health condition or disability may be required to determine eligibility. This information may be obtained through an in-person assessment or by requesting information from a professional who understands my health condition or disability. Additional information will be required only when the information provided on the application form does not clearly determine ADA paratransit eligibility.

Applicant’s Signature:_____________________________________________ Date:______/______/______

*If the applicant is not his/her own guardian, the following information about the guardian is required:

Guardian’s Name: (please print) _______________________________________________________________________________

	First	Middle Initial	Last
Day Phone: (	) ______________________________________________________

Guardian’s Signature: _____________________________________________ Date:______/______/______

*If someone other than the applicant or the applicant’s guardian is preparing this form, please provide the following information about the preparer:

Name: (please print) _________________________________________________________________________________________

	First	Middle Initial	Last
Day Phone: (	) ______________________________________________________

Preparer’s Signature:______________________________________________ Date:______/______/______

ELIGIBILITY APPLICATION PROFESSIONAL VERIFICATION

Americans with Disabilities Act (ADA)

1.Complete and sign the “Authorization to Release Information”.

2.Send to your designated professional.

3.Wait for the professional to return this form to you.

Check back with your professional if you don’t receive your information.

4.This form is incomplete if it is NOT ACCOMPANIED BY COMPLETED CERTIFICATION QUESTIONNAIRE.

WE DO NOT ACCEPT APPLICATIONS BY FAX

AUTHORIZATION TO		PLEASE PRINT OR TYPE
SECTION A RELEASE INFORMATION		PLEASE PRINT OR TYPE
SECTION A RELEASE INFORMATION

(WHEN COMPLETE SEND TO THE PROFESSIONAL YOU NAMED)

Applicant’s Name: First	Middle Initial	Last
Birth Date:______/______/______

Applicant’s Address: ________________________________________________ Apt.#:____________________

City: ___________________________________________ State:_____________ Zip Code: ________________

Applicant’s Telephone Number (

) ______________________________

Name of Professional: _______________________________________________ Title:_____________________

Applicant’s Signature: ____________________________________________ Date: ______/______/______

Guardian’s signature required if the applicant is not his/her own guardian,

Guardian’s Signature:_____________________________________________ Date: ______/______/______

SECTION B METRO MOBILITY PROFESSIONAL VERIFICATION FORM

Dear Health Care Professional:

You are being asked to provide information regarding this individual’s disability. The Federal Law is very speciic about ADA para-transit eligibility. The law restricts eligibility to individuals who,

1.as a result of their disability, cannot board, ride, or disembark from a regular ixed route bus or light rail car or

2.have a speciic impairment-related condition which prevents them from getting to or from a bus stop.

PLEASE NOTE: This does not include persons who ind it dificult or uncomfortable to get to and

from bus stops. In providing information you should consider only the presence of a disability or health condition and not the applicant’s age or economic status.

THIS SECTION MUST BE FILLED OUT FOR ALL APPLICANTS

GENERAL INFORMATION

•Describe the diagnosed disability you are currently treating this individual for: _____________________

____________________________________________________________________________________________

• Describe any other health conditions or disabilities with which this individual is diagnosed:__________

____________________________________________________________________________________________

•Date of onset ____/____/____

•Date of last visit ____/____/____

•How long have you worked with the individual? Since ____/____/____

•Is disability temporary ________ or permanent ________ ?

If permanent is disability progressive? ____Yes ____No

If temporary please give best estimate of rate of recovery. ___________________________________

• Is therapy part of treatment? ____Yes ____No If yes, give brief description ______________________

____________________________________________________________________________________________

• Do temperature extremes affect the individual?

(Ex. Heat index of more than 85 degrees or wind chill less than 10 degrees) ____Yes ____No

If yes, how so? _________________________________________________________________________

• Please list all medications. _____________________________	____________________________
_____________________________	____________________________
_____________________________	____________________________

•Is this individual compliant with taking medications? ____Yes ____No

•Does the individual currently uses regular route public transportation? ____Yes ____No ____Not Sure

•Is the individual’s judgment impaired ____Yes ____No

•Is behavioral inhibition impaired? ____Yes ____No

•Can the individual walk? ____Yes ____No

• Does the individual use a mobility aid? ____Yes ____No Please list ____________________________

____________________________________________________________________________________________

•How long has individual been using the device(s)? _____________________________________________

____________________________________________________________________________________________

• How far can the individual travel without the assistance of another person?

3 blocks

6 blocks

9 blocks or more

less than 3 blocks

•With treatment/therapy will this distance increase? ____Yes ____No

•Please indicate the expected distance after treatment/therapy:

3 blocks

6 blocks

9 blocks or more

less than 3 blocks

•Give best estimate of length of time required to achieve this improvement. _______________________

____________________________________________________________________________________________

PLEASE COMPLETE ONLY THOSE SECTIONS THAT APPLY TO THIS INDIVIDUAL

NEUROLOGICAL IMPAIRMENT/HEAD INJURY

• Does the individual experience seizures? ____Yes ____No Date of last seizure ______/______/______

•Please give no. of seizures ________ and frequency ____________________________________________

•What type(s) of seizures does patient experience_______________________________________________

•Does individual experience auras? ____Yes ____No

•Is the individual’s judgment impaired? ____Yes ____No

•Is behavioral inhibition impaired? ____Yes ____No

•Does judgment and inhibition impairment prevent the individual from independently traveling outside the home or immediate environment? ____Yes ____No

•When traveling independently does the individual have the ability to: (check all that apply)


Get help if lost	Recognize & avoid danger		Cross streets safely
Follow written directions		Communicate needs	Process information

Understand and follow schedule to get places on time

• Is there history of Brain Injury ____Yes ____No. Date of injury______/______/______

VISUAL IMPAIRMENT

•Please provide visual acuity measurements and visual ield readings for both eyes. OS: __________________________ OD: ________________________________

•Does the individual require any accommodations, adaptations, low vision aids, etc? Please list:

____________________________________________________________________________________________

• How does the individual’s visual impairment affect their ability to move about in the environment?

____________________________________________________________________________________________

• Has the individual received any orientation & mobility (O&M) training? ____Yes ____No

3	Questions? Please call 651-602-1111

• Does the individual experience any of the following:
Auditory hallucinations	Visual hallucinations	Delusions	Disassociation

•Does this prevent the individual from being oriented to person, place, and time? ____Yes ____No

•Is the individual currently being treated for any of the following:

Anxiety	Depression	Panic attacks	Schizophrenia
Other: _____________________

•For anxiety panic attacks please indicate on average the frequency and length of panic attacks. Per day________ Per week________ Per month________ Per year________

Approx. duration: ________

•What technique(s) and/or skills is the individual utilizing to assist in coping with the above issue(s)?

Visualization	Relaxation techniques	Positive self-talk	Aroma therapy
Other:______________________

•Are these techniques effective in reducing symptoms? ____Yes ____No

•Is there a history of Electroconvulsive Therapy (ECT)? ____Yes ____No ____Unknown

COGNITIVE/MENTAL IMPAIRMENTS

Please list IQ score and GAF score if known. IQ = ___________ GAF = ___________

•Please describe the functional limitations caused by this impairment?

___________________________________________________________________________________________

•Is the individual’s judgment impaired? ____Yes ____No

•If yes, please describe to what extent or give an example.______________________________________

_________________________________________________________________________________________

• Is the individual able to live independently? ____Yes ____No

Additional Comments: ____________________________________________________________________

___________________________________________________________________________________________

MMSC Staff will make the inal determination of the applicant’s eligibility

Doctor/Health Care Professional Signature: _________________________________________________

PLEASE RETURN FORM TO APPLICANT PLEASE PRINT so that we may contact you if needed Name of Professional: ______________________________________________ Date: ______/______/______

Title: _______________________________________________________________________________________

Street Address:______________________________________________________________________________

City: _____________________________________ State: ________ Zip Code: _________________________

Telephone Number: (

) ____________________________ Fax: (

) _____________________

Get Metro Mobility Application PDF Form

Form Characteristics

Fact Name	Description
Required Forms	Applicants must submit two completed forms: the Certification Questionnaire Form and the Professional Verification Form.
Professional Verification	A qualified professional must complete the Professional Verification Form on behalf of the applicant. This includes physicians, therapists, and certain social workers.
Authorization to Release Information	The Authorization to Release Information must be signed by the applicant, allowing a designated professional to share necessary information to assess paratransit eligibility.
Submission Method	Both forms must be submitted together in one envelope. Fax and email submissions are not accepted.
In-Person Assessment	An in-person assessment may be requested if additional information is needed to determine eligibility. This includes interviews and mobility evaluations.
Processing Timeline	The Metro Mobility Service Center aims to process applications within 21 calendar days. If it fails to do so, presumptive eligibility will be granted.

Guidelines on Utilizing Metro Mobility Application

Filling out the Metro Mobility application may seem daunting, but with careful attention to detail, it can be done smoothly. Following the outlined steps will guide you through the process of completing the necessary forms accurately, ensuring you meet the eligibility requirements without unnecessary delays.

Gather the Required Forms: Make sure you have both the Certification Questionnaire Form and the Professional Verification Form on hand.
Complete the Certification Questionnaire: Fill out the Certification Questionnaire Form completely. Include personal details like name, address, and contact information. Sign the form yourself, or if you're a guardian, ensure you sign on behalf of the applicant.
Seek Professional Verification: Identify a qualified professional from the provided list, such as a physician or physical therapist, to complete the Professional Verification Form. Send them the form along with the “Authorization to Release Information” section already filled out with your information.
Follow Up: Check in with the professional to confirm that they have returned the completed Professional Verification Form to you.
Review Both Forms: Before submission, double-check that both forms are fully completed and signed. It is essential that no information is missing and that the professional's title and credentials are clearly stated.
Submit Both Forms Together: Place both the Certification Questionnaire and the Professional Verification Form in the same envelope and mail them to Metro Mobility Service Center at the following address:
390 N. Robert Street
Saint Paul, MN 55101-1805.

After submitting the forms, the Metro Mobility staff will review your application. If they require additional information, they may schedule an in-person assessment to ensure all factors are considered in determining your eligibility. It's also reassuring to know that the processing time for applications is typically within 21 calendar days. If your application isn't processed by then, you will receive presumptive eligibility for Metro Mobility service until a final decision is made.

What You Should Know About This Form

1. What are the main components required for the Metro Mobility Application?

The Metro Mobility application consists of two essential forms: the Certification Questionnaire and the Professional Verification Form. Both forms must be completed and submitted together in a single envelope. The Certification Questionnaire should be filled out by the applicant or their advocate, and it requires a signature from both the applicant or their guardian and anyone who assisted in completing the application. The Professional Verification Form must be completed by a qualified professional familiar with the applicant’s condition, and their credentials must be clearly included on the form.

2. Who can complete the Professional Verification Form?

A variety of professionals can assist with the Professional Verification Form. Acceptable individuals include physicians, psychiatrists, occupational therapists, psychologists, physical therapists, and licensed social workers, among others. Essentially, anyone in a healthcare or related field who can speak to the applicant’s mobility needs may qualify. It’s crucial that the professional signs the form and includes their title and credentials; otherwise, the application could be deemed incomplete.

3. What should I do if I don’t receive the Professional Verification Form back in a timely manner?

If the Professional Verification Form is not returned promptly, reach out to the professional you designated to complete it. Sometimes, a little nudge is all it takes to get things moving. Remember, it’s essential to get this form back as soon as possible, as failing to submit both forms together will result in an incomplete application.

4. What happens if my application is incomplete?

If the Metro Mobility Service Center finds an application to be incomplete, they will return it to the applicant one time. It's essential to double-check that all required information is present before submission to avoid delays. If an application is submitted a second time and is still incomplete, it will be held for 60 days before being discarded. A properly completed application must be processed within 21 calendar days. If there’s any issue during that time, you’ll be granted presumptive eligibility for Metro Mobility services while your application is being processed.

Common mistakes

Filling out the Metro Mobility Application form can sometimes feel overwhelming. Mistakes can lead to application delays, which can be frustrating. Here are five common errors to watch out for.

First and foremost, not submitting both required forms is a critical mistake. The application requires the Certification Questionnaire and the Professional Verification Form. Submitting only one of these will result in an incomplete application. Always check to ensure both forms are included in the same envelope before sending.

Another frequent error is forgetting to sign the forms. Both the applicant and the professional completing the Professional Verification must sign their respective sections. Failing to do so will render the application incomplete. Ensure that every necessary signature is obtained to prevent any unnecessary delays.

In addition, omitting professional credentials is a common oversight. When a professional signs the Verification Form, they must include their title and credentials. For example, a signature that simply says "Jane Doe" is not sufficient. It needs to identify their qualifications, such as "Jane Doe, M.D." This detail is crucial for verifying the professional’s legitimacy.

Some applicants also neglect to provide complete contact information. An incomplete mailing address or missing telephone numbers can complicate the processing of the application. Make sure all sections are filled out accurately, including any emergency contact information.

Lastly, not following submission guidelines can lead to complications. Applications must be sent to the designated address and cannot be submitted by fax or email. Address envelopes carefully and double-check that you're following the instructions exactly as listed to ensure your application is processed swiftly.

Documents used along the form

When applying for Metro Mobility services, several accompanying documents are essential to ensure a complete application. Each form serves a specific purpose that helps determine eligibility. It is important for applicants to pay close attention to these requirements to streamline the process.

Certification Questionnaire Form: This is the primary application form that gathers essential information about the applicant. The applicant or their advocate must complete it in full and sign it to verify the details provided.
Professional Verification Form: Completed by a qualified professional who knows the applicant's condition, this form verifies the applicant's need for service. It must accompany the Certification Questionnaire for the application to be considered complete.
Authorization to Release Information: This authorization allows the professional to share necessary information about the applicant's condition with Metro Mobility. It must be completed and sent to the designated professional for their signature.
In-Person Assessment Documentation: In certain cases, an applicant may be required to participate in an in-person assessment. Documentation related to this assessment outlines what information will be covered during the appointment to evaluate mobility and functional ability.
Emergency Contact Information: Applicants must provide information for an emergency contact person. This ensures that, should an issue arise during service, there is someone readily available to assist.
Proof of Disability or Medical Condition: This may include medical records, previous diagnoses, or other relevant documents that help substantiate the applicant's eligibility for Metro Mobility services.

Ensuring that all these documents are completed and submitted together can help prevent application delays. By carefully preparing each part of the application, applicants can facilitate a smoother process in securing the mobility services they need.

Similar forms

Disability Services Application Form: Similar to the Metro Mobility Application, this form requires detailed personal information and documentation of disability status to determine eligibility for disability services.
Public Assistance Application: Just like the Metro Mobility Application, this document collects comprehensive data about the applicant’s situation to assess eligibility for public aid programs.
Health Insurance Application: This form gathers health history and personal details, mirroring the importance of medical verification in both Metro Mobility and health insurance eligibility processes.
Vocational Rehabilitation Application: This application seeks detailed information about the applicant's background and disability to evaluate eligibility for job training and support services.
Specialty Transit Program Application: This document, similar in nature, outlines the need for assistance and requires professional backing to support requests for specialized transit services.
ADA Access Request Form: Like the Metro Mobility Application, this form requests information about personal needs related to accessibility, highlighting the importance of supportive documentation.
Food Assistance Program Application: This application demands personal and financial details akin to Metro Mobility, with a focus on eligibility requirements for nutritional support.
Housing Assistance Application: Each of these forms underscores the necessity of validating financial and personal circumstances for determining eligibility for housing-related aid.
Autism Services Eligibility Form: Akin to the Metro Mobility Application, it collects essential details about the individual's condition and requires evaluations from professionals in the relevant field.
Senior Services Assessment Form: Like the Metro Mobility Application, this document is designed to gather comprehensive information about the applicant’s needs and the availability of appropriate services.

Dos and Don'ts

When filling out the Metro Mobility Application form, careful attention is required to ensure that all required information is completed correctly. Below are five things you should and shouldn't do to facilitate the process.

Do fill out both the Certification Questionnaire and Professional Verification forms completely.
Don't skip any sections or leave any questions unanswered, as this may lead to delays in processing.
Do ensure that both forms are signed by the necessary parties before submission.
Don't submit partial applications; both forms must be submitted together in the same envelope.
Do double-check that the professional verifying your information includes their title and credentials when signing.

Misconceptions

Misconception 1: Only one form is needed.

Applicants must submit both the Certification Questionnaire Form and the Professional Verification Form. Omitting either form will result in an incomplete application.
Misconception 2: Anyone can fill out the Professional Verification Form.

This form must be completed by specific professionals, including physicians, therapists, and counselors, who are familiar with the applicant’s condition.
Misconception 3: Applications can be submitted via fax or email.

Metro Mobility does not accept applications submitted by fax or email. All forms must be mailed together in the same envelope.
Misconception 4: Signatures are not important.

Both forms must be signed by the applicant or their guardian, as well as by the designated professional on the Professional Verification Form. Missing signatures lead to incomplete applications.
Misconception 5: The in-person assessment is always required.

Typically, the submitted forms provide sufficient information for processing. However, an in-person assessment may be requested if additional information is needed.
Misconception 6: Applications take a long time to process.

Properly submitted applications are processed within 21 calendar days. If not processed in this timeframe, applicants are granted presumptive eligibility.
Misconception 7: There are no guidelines on who can assist the applicant.

Only designated professionals should complete the Professional Verification Form. Family or friends may assist with the Certification Questionnaire if needed.
Misconception 8: The forms can be completed in any format.

All forms must be filled out using printed or typed text to ensure clarity and legibility, avoiding any confusion during the review process.

Key takeaways

Completion of Both Forms is Required: Each application must include two forms: the Certification Questionnaire and the Professional Verification Form. Incomplete submissions will delay the processing of your application.
Signatures are Essential: Ensure that all required signatures are present. Both applicants and any assisting parties must sign the Certification Questionnaire, while the Professional Verification Form requires the professional's signature as well.
Professional Verification is Critical: The Professional Verification Form must be filled out by an appropriate professional familiar with the applicant's condition. Confirm that their title and credentials are included to avoid incompleteness.
Submission Method Matters: Applications should be mailed to the designated address. Metro Mobility does not accept applications via fax or email, which could result in further delays.
Be Prepared for an In-Person Assessment: If additional information is needed for eligibility determination, applicants may be required to attend an in-person assessment. This step is crucial for those whose applications present as incomplete after initial submission.

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