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Application for Transportation Services

SCHUYLKILL TRANSPORTATION SYSTEM
Application for Transportation Services
Persons with Disabilities (PwD), Americans with Disability Act (ADA), Senior Shared Ride 65+, Public Full Fare

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Instructions

1. Transportation services may be available at a reduced rate if you meet any of the following criteria:
a. Currently on Medical Assistance through the Department of Human Services. MATP can be reached at (570) 628-1425 or (888) 656-0700 (medical appointments only)
b. A person with a disability and aged 18-64
c. A person who lives along the fixed route, but due to a disability is unable to access it
d. Aged 65 or older and reside in Schuylkill County, please contact the Schuylkill County Office of Senior Services at 570-622-3103.

2. If you would like to apply, please complete this form and send it with a copy of the documents listed
to the below address:

SCHUYLKILL TRANSPORTATION SYSTEM
P.O. Box 67
Saint Clair, PA 17970

3. Once your application is received and reviewed you will be notified of your eligibility to participate.

4. If you have any questions about this application please call:
Toll Free Phone: (800) 832-3322 or (570) 429-2701

NOTE: The information provided in this application regarding your age, disability, and county residence will be used to determine your eligibility for shared ride transportation services under the Rural Transportation for Persons with Disabilities and Senior Shared Ride programs.

Other information within the form will be used for data collection purposes, to determine your eligibility for any additional transportation programs, and provide you with appropriate referral service (MATP, ADA, MH/IDD).

This information will be kept confidential and used only by the professionals involved in evaluating your eligibility.

Also included with your application is a Voter Declination Form. STS is required by Federal law to provide this form to all applicants and can be returned with your completed application. Your elections will not affect your eligibility.