Access Application Form

bus

This application is also available in large print, audio tape, and braille. If you need this information in alternative formats or additional information, please call 615-880-3596 and ask for the Eligibility Specialist.



If YES:

Applicant’s personal/contact information





Mailing Address (if different from home)

Emergency Contact

Functional Abilities






















WeGo offers free travel training to anyone interested in learning how to ride buses.







Certification of Application

I hereby certify that, to the best of my knowledge, information given in this application is correct. I understand that this application will be returned if it is not complete. I further understand that the results of this review will be based on my ability to use regular bus (MTA) transportation and may require additional information from me, such as a phone or personal interview, or additional consultation from my physician or other professional.

I agree to notify WeGo Access if I no longer require Access for any reason, including a change in my ability to use bus service. I also understand that failure to adhere to the policies and procedures for using Access may be grounds for suspension or revoking my eligibility to participate in this program.

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