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2. 
4. Name
5. Email Address
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Date
    Date
15. Date of Birth
    Date of Birth
16. Sex

    1. Male
    2. Female

    Please select an option
18. Emergency Contact Information
20. Name
21. Relationship
23. Address
25. City
26. State
27. Zip Code
29. Phone Number
31. Please Select the service(s) that you are applying for:

    1. Elderly/Disabled
    2. Senior Center

    1. Rural General Public
    2. Employment

    Check all that apply

33. ADA (paratransit service)
    ADA Paratransit Service Application

    If your home address is within 3/4 mile of an Orange County Fixed Route, please complete the ADA form linked above.

35. Medical Equipment

    1. Oxygen
    2. Manual Wheelchair
    3. Power Wheelchair

    1. Scooter
    2. Walker
    3. Service Animal

    Select all that apply

37. Mobility Status

    1. Ambulatory (able to walk and move independently)

    1. Non-Ambulatory (unable to walk or move around independently)

    Please select the option that applies

39. Care Attendant Required

    1. Yes
    2. No

    Please select the options that applies

41. Demand Response Service Guidelines

    The OC ACCESS Demand-Response Service provides countywide curb-to-curb transportation for the rural general public, seniors, and individuals with disabilities. Service operates weekdays from 6:30 a.m. to 4:30 p.m. Trips may be scheduled up to seven days in advance and no later than two business days before the appointment, and reservations can be made Monday through Friday, 8:00 a.m.–3:00 p.m. (Sunday requests may be left by voicemail). Ride requests are booked on a first-come, first-served basis, and the fare is $3.00 each way.

    Demand-Response provides curb-to-curb service with the following guidelines:

    • A 30-minute pickup window
    • Scheduling within one hour of the requested time

    Additional guidelines include:

    • No subscription trips; all requests must be made individually within the allowed scheduling window
    • Transit service requests must be submitted between 9:00 a.m. and 3:00 p.m.

    Passengers must call OCPT Dispatch at (919) 245-2008 for their return trip

    Passengers must be ready to board for their return by 4:30 p.m., as no service is provided after that time

43. Instructions for Submission
    This application can be submitted online with the option of receiving a copy by email. You can also print out the application and submit it by mail or fax to our Administration Office. Mailing Address: 600 NC 86 Hillsborough, NC 27278 Fax Number: 919-732-2137
45. Client Signature
    Please type your First and Last Name in the section above.
46. Processing Consent

    1. Agree and Consent

    By checking this box you consent to Orange County Public Transportation processing your application.
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48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit Submit and Print

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