Request for Professional Verification - WOTA

Skip to content

248-887-4979

Call to Schedule

Menu

Home
Rider Guidelines
- Rider Guidelines
Application to Ride
- Application to Ride
About WOTA

Menu

×

Home
Rider Guidelines
- Rider Guidelines
Application to Ride
- Application to Ride
About WOTA

Request for Professional Verification

Applicants Name*
THESE TWO PAGES MUST BE FILLED OUT BY PROFFESSIONAL North Oakland Transportation Authority (NOTA) requires verification by a professional in order to qualify disabled individuals requesting service for transportation. Please fill in all sections that pertain to the applicant’s disabilities as they relate to using public transportation. If you have any questions, please call (248) 693-7100.
1) What is your professional relationship to the applicant?*
2) What is/are the applicant’s disabilities/diagnosis?*
3) Is this disability temporary? If yes, until:*
4) Please list the mobility aid(s) that the applicant uses to your knowledge:*
5) Is the applicant legally blind?*
- Yes
- No
6) Does the applicant have a cognitive disability?*
- Yes
- No
7) Does the applicant exceed 400 pounds? (Vehicle Lift Restrictions)*
- Yes
- No
8) Is the applicant able to?
a) Give address and telephone numbers upon request:*
- Yes
- No
b) Recognize a destination or landmark:*
- Yes
- No
c) Deal with unexpected change in routine?*
- Yes
- No
d) Ask for, understand and follow directions?*
- Yes
- No
Please explain any OTHER responses from question #8 above or describe any other effects of the disability not already provided elsewhere on this form
Professional's Name*
Title/Position*
Permanent Professional License/ID#*
Name of Organization*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
I hereby certify that the information given above and in this application is correct.
Professional's Signature*
Date of Signature*
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

Δ

Call to Schedule

Service Area

Color-coded map showing areas around Flint, Michigan.

Hours of Operation

Dispatch Hours

Monday - Friday 8:00 a.m. to 4 p.m.

Saturday Closed

Sunday Closed

Driving Hours

Monday - Friday 6:00 a.m. to 9:00 p.m.

Saturday 8:00 a.m. to 4:00 p.m.

Sunday Closed

Employees | ADA Compliance Guidelines | Privacy Policy

Copyright © 2019-2025

Powered by Civic Clarity®

Scroll To Top