Transcription of Persons with Disabilities TAP card Application
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Persons with Disabilities TAP card Application
16-1661EH 2017 LACMTAPage 1 of 4 The Persons with Disabilities TAP Card Program makes it easy for passengers with Disabilities to qualify for reduced fares at TAP-participating agencies. Call for eligibility requirements or additional instructionsn All applicants are required to complete SECTIONS 1, 2, and If an applicant has a qualifying medical disability (see SECTION 4), then he or she is also required to complete SECTION 5 and must request a doctor or other certifying professional to complete and sign the required fields in SECTION Include a copy of official photo Include documents proving eligibility from SECTION Include the completed medical certification in SECTION Submit completed Application in person or by mail.
Unless revoked, this form will permit the health care professional certifying my disability to release pertinent information for up to 60 days after the date appearing below. _____ _____ _____ Applicant Name (Print) Applicant Signature Date Persons with Disabilities TAP card Application complete o ualify or educed res tAP-participating ransit ...
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