APTA Award

Paratransit Service Application

  1. Eligibility Questionnaire

    This form must be completed by the applicant or someone authorized to sign on the applicant’s behalf.
  2. Professional Verification Form

    All applicants must sign the Authorization for the Release of Information included in part 2, page 1. The rest of the form must be completed by a professional who is familiar with the applicant’s condition and qualified to respond (see right).
  3. Submit Both Forms Together

    Submit both the Blue Eligibility Application and the Green Professional Verification together. All applications will be processed within 21 calendar days of receipt of the completed packet and the applicant will be notified in writing of Mountain Line’s determination of eligibility.

Avoid Delays in Application Process

  • All pages for both forms must be submitted
  • Check that all questions have been answered
  • Make sure all needed signatures are present
  • Double check the professional credential section is complete

An incomplete application will be returned to the applicant one (1) time with a notice of what is missing. If it is returned to Mountain Line Paratransit incomplete a second time, the applicant will be sent a new blank application to complete.

List of Qualified Professionals:

  • Physician or Psychiatrist
  • Physical Therapist
  • Physician Assistant
  • Licensed Clinical Social Worker (LCSW)(LCPC)
  • Occupational Therapist
  • Registered Nurse or Nurse Practitioner
  • Psychologist
  • Certified Orientation and Mobility Specialist
  • Speech/Language Pathologist

Mountain Line recognizes that many professionals work with clients that are disabled and the list above is not meant to exclude those professionals. In general, this will require completing a multi-year degree program and/or being licensed by the State of Montana. A primary care physician is often able to adequately complete this form. You do not need to visit a specialist.

In-Person Assessment

The eligibility of most applicants can be determined by the forms submitted to Mountain Line staff. However, there may be cases where Mountain Line requests to conduct an in-person functional assessment of an applicant’s disability. This assessment may include, but is not limited to:

  • A conversation about the applicant’s mobility
  • Reading a bus schedule to plan out a bus trip
  • Taking a short walk
  • Practice boarding an actual bus

If an in-person assessment is requested, your application will still be processed within 21 calendar days of receipt. Transportation will be provided.

Eligibility Application

Applicant Information

Legal Guardian Information

In case of emergency, who should we contact?

Who is authorized to contact Mountain Line on your behalf?

General Information

Required Assistance

Are you able to complete the following tasks without assistance from another person?
Check a box for each question. If you answer sometimes for any questions please explain.

Disability Information

These questions help describe your disability and how it may impact you.

(Note: Mountain Line operators are not allowed to cross the outer threshold of any residence, facility or business.)

Application Signature

I understand that the purpose of this application is to determine if the applicant is eligible to use ADA Paratransit Service. I certify that the information provided in this application is true and correct. I understand that falsification of information could result in the denial of ADA Paratransit services as well as a penalty under the law. I agree to notify Mountain Line if my circumstances change and I no longer need to use ADA Paratransit Services. I understand that I am responsible for authorizing a Professional Verification of my condition(s). I also understand that a follow-up conversation, an informational meeting or functional assessment by a professional selected by Mountain Line may be requested.