Laketran Reduced Fare Application

Individuals who would like to participate in Laketran's Reduced Fare program for Local Routes, Dial-a-Ride or Park-n-Ride must complete a Reduced Fare program application.

Laketran offers reduced fares to seniors, individuals with disabilities, veterans, and students. Persons eligible for reduce fare for each mode of service include:

Local Routes: Seniors, Individuals with disabilities, Veterans, Students
Dial-a-Ride: Seniors, Individuals with disabilities, Veterans
Park-n-Ride: Seniors, Individuals with disabilities, Veterans, Students

In order to qualify for a reduced fare, the applicant must provide proof of eligibility by submitting one of the following forms of documentation with their application.

Seniors (Age 60 and over)	Individuals with Disabilities
- Golden Buckeye Card	- Golden Buckeye Card
- State issued ID	- Medicare Card
- Medicare Card
- Birth Certificate	Students
	- College Student ID
Veterans	- High School ID
- Military ID
- DD-214	*Other transit system Reduced Fare photo IDs
	are acceptable as proof of eligibility.

The applicant will need to fill out the information in Part 1 of the Reduced Fare application. Please make sure the information provided is complete, accurate and legible. In Part 2, the applicant provides proof of eligibility by attaching qualifying documentation. If the applicant does not have anyof the documentation listed above, a medical professional, educator, social worker, or agency must verify eligibility for the Reduced Fare program by completing Part 3 of the application.

If you have any questions or need assistance to complete this form, please contact Laketran's Outreach Specialist at 440-350-1067 or outreach@laketran.com.

Application Guidelines

Applications not completed correctly will not be processed. Do not forget to include a photo.
The eligibility criteria of the application assists Laketran in determining if the applicant is eligiblefor the Reduced Fare program.
Persons with disabilities are defined by FTA as persons "who by reason of illness, injury, age, congenital malfunction, or other incapacity or temporary or permanent disability - including any individual who is a wheelchair user or has semi-ambulatory capabilities" (49 CFR 609.3).
Laketran reserves the right to contact any qualifying agency that completed this form. Any fees charged for the completion of the application are not the responsibility of Laketran.
Applications for seniors, veterans, individuals with disabilities will not expire unless the qualifying disability is considered temporary. Student applications must be renewed annually.
Regular fares must be paid until application is approved. Please allow 10 business days to process the application.
There is a $5.00 replacement fee for lost or stolen cards.
Printed applications are available by request at 440-350-1067.

Part 1: Background Information of Applicant

Name*

Address*

City*

State*

Zip Code*

Phone Number*

Phone number with area code

Email*

example@example.com

Date of Birth

MonthDayYear

Emergency Contact

Phone Number

Phone number with area code

Please check your eligibility for the Reduced Fare program. Please check all that apply.*

SeniorDisabledVeteranStudent

Please check all that apply.*

Add my eligibility to my EZfare account (EZfare account email must match email above)Add my eligibility to my Dial-a-Ride/Request-a-Ride accountI prefer to pay by cash or bus pass. Please mail me a Laketran Reduce Fare ID to show when boarding the bus.

Please upload a photo of yourself for your ID card.*

I certify that the above information is true. I understand that if this application is approved, I will be issued a reduced fare eligibility on my EZfare and/or Dial-a-Ride account, or be issued a Reduced Fare photo identification card to use until the indicated expiration date on the card. I agree not to lend my card to anyone. I agree to present my card to the bus operator when paying my fare.*

Date*

MonthDayYear

Part 2: Qualifying Documentation

Upload documentation to show proof of eligibility. See accepted proofs of eligibility above. If you do not have documentation to show proof of eligibility, have a doctor, caseworker, or other qualifying agency complete Part 3 of this application.

Part 3: Qualifying Agency

Agency

Staff Member

Agency Address

City

State

Zip Code

Phone Number

Phone number with area code

Email

example@example.com

Please check the following qualifier:

SeniorDisabled*VeteranStudent

*The impairment or disability is considered:

PermanentTemporary**

**If the impairment or disability is considered temporary, please estimate duration of disability (date)

MonthDayYear

I certify that the applicant meets one or more of the above qualifiers to receive a reduced fare on Laketran as defined by the above criteria and that the information I have provided is true and correct.

Signature

Date

MonthDayYear