Please enter your name, address and telephone number. Your E-mail address is optional. Click the "Submit Form" button when you are ready to send the form, and a ADA Paratransit Eligibility Certification Request Form will be mailed to you as soon as possible. Use the "Reset" button if you want to clear the information in the form and start over. Thank you for your interest in the ADA Paratransit Eligibility program.