-
Eligibility Questionnaire
This form must be completed by the
applicant or someone authorized to sign
on the applicant’s behalf.
-
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).
-
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.
