Reduced Fare Application 2026

Demand & Response Service Application
and
Reduced Fare Application (for fixed routes)

There are several types of public transportation available throughout the State of Maryland, depending on the county in which you reside. We are pleased to inform you that Carroll County, through the cooperation of the Board of Commissioners of Carroll County, MD, offers citizens a Fixed Route System and Demand & Response within Carroll County.

Fixed Route Service: Bus service has designated bus stops along specific routes on set schedules. All buses now have features to make riding easier for people with disabilities, including wheelchair lifts and voice announcements. For Fixed Route schedules and maps, please see this website: www.CarrollTransitSystem.com

Demand & Response Service: Door-to-Door shared ride public transportation service for people whose disability and/or residential location prevents them from using Fixed Route Service. On an individual, case-by-case basis, Carroll County public transit will assist riders beyond the curb when riders need such assistance to travel from their origin to their destination. You must call in advance to make a reservation to travel. We also created a Riders Guide to help you understand how to ride the Carroll County public transit system. You can access the Riders Guide at the following website: www.CarrollTransitSystem.com

If your disability or environmental barriers prevent you from using Fixed Route Service, you may be eligible for Demand & Response (Door-to-Door) Paratransit Service some or all of the time. Your ability to ride Fixed Route buses will be evaluated through the use of this application.

IMPORTANT: Medical condition or eligibility for other disability programs does not necessarily qualify you to use Demand & Response (Paratransit) Service (Curb-to-Curb

What is the Americans with Disabilities Act (ADA)? The Americans with Disabilities Act (ADA) is a civil rights law. The intent of the ADA is to remove barriers that have prevented people with disabilities from fully participating in life. Under the ADA, Fixed Route service is to be the primary means of public transportation for everyone, including people with

Travel Training: Carroll County, Butler, and CMRT offer free one-on-one and/or group training to teach people with disabilities how to ride our Fixed Route buses. For more information, please call for travel trainer services at: 410-363-0622

Print Applicants Name

Carroll Transit System

Demand & Response Service Application
Reduced Fare Application (for fixed routes)

To ensure your application is processed in a timely manner, all questions must be answered. Part A and Part B must be submitted at the same time. Incomplete applications will be returned to the applicant and/or individual/agency completing the application. All information is kept confidential and may be utilized for internal and/or operational uses, including contact with the customer's treatment centers/employees and other contacts provided by the applicant/customer.

PART A: General information regarding the applicant. To be completed by applicant or an individual in behalf of the applicant. I hereby authorize the release of information requested on this certification for use in evaluating my eligibility for services operated by Butler Mobility on behalf of Carroll County, Maryland. I authorize staff to contact the professional(s) who completed this form if clarification of information is needed, and authorize this professional(s) to release all pertinent information.

Choose One

Last Name

First Name

MI

Street Address

Apt or Room No

Name of Development or Apartment Complex

City

State

Zip

Mailing Address if different

Home Phone

Format: (000) 000-0000.

Cell Phone

Format: (000) 000-0000.

Work Phone

Format: (000) 000-0000.

Email Address

example@example.com

Date of Birth

Date

Last four 4 Digits of SSN

Weight in lbs

Client ID

Birth Certificate (copy) Provided?

Emergency Contact 1

Name

Relationship

Home Phone

Please enter a valid phone number.Format: (000) 000-0000.

Cell Phone

Please enter a valid phone number.Format: (000) 000-0000.

Work Phone

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Emergency Contact 2

Name

Relationship

Home Phone

Please enter a valid phone number.Format: (000) 000-0000.

Cell Phone

Please enter a valid phone number.Format: (000) 000-0000.

Work Phone

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

If information is required in an alternative format, please call 410-363-0622

Print Applicants Name

Applicant must accurately and legibly complete each of the following questions.

1. Describe your disability and how you believe it prevents or limits your use of the regular fixed route

2. Is this condition/s temporary?

If temporary what is the expected duration

Years

or end date?

Date

3. Do you need a (PCA) Personal Care Assistant?

4 How does the PCA assist you such as getting to your destination or with activities after you arrive at your destination

5. Do you need a Service Animal?

What type of service animal do you use

6 What task has the animal been trained to perform

7. How do you travel now? Check all that apply.

Name alternate route of travel if choosing "Other"

Have you used fixed route bus service before?

Where do you go?

List Others

8. Which of these aids do you currently use when traveling? Check all that apply.

Power Wheelchair Weight

Power Wheelchair Height

Power Wheelchair Width

Note: Manual and Power Scooters and Wheelchairs must be able to be safely accommodated with the vehicle's lift and must be secured for transportation. Maximum Weight may vary based on the lift's safety capacity when fully loaded.

Do you need assistance when you travel in the community?

What type of assistance do they provide for you

Applicant Verification and Signature Application must be signed to be considered complete.

I understand that the purpose of this application form is to determine if there are times when I cannot use Carroll Transit System fixed route buses and will require Demand & Response/Paratransit services. I understand that the information on this application will be kept confidential and shared only with the County staff and other professionals involved in evaluating my eligibility. I certify that to the best of my knowledge, the information on this application is true and correct. I understand that providing false or misleading information could result in my eligibility status being terminated.

I give permission for /County staff to contact the professional(s) who filled out information on this application or submitted supplemental verification of my condition.

Applicant Printed Name

Date

Applicant Signature

Person filling out this form if other than Applicant (Check One)

Print Name

Signature

Relationship to Applicant

Home Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Cell Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Work Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState

Zip

Agency Name

Agency Address

Agency Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Part A and Part B must be submitted together If only one section is received, the application will be returned to the applicant.

Mail To: Carroll Transit System

1300 Old Meadow Branch Rd, Westminster, MD 21158

Scan and email to: ctsinfo@rwu.today

If you do not have Part A from the applicant, you must return Part B to the applicant. Parts A and B must be submitted together.

In order to complete this application on behalf of the applicant, you must be a certified or licensed Health Care professional. (See Chart below for details of Health Professionals) The applicant is asking you to review the information on this application and to complete and sign Part B of this form certifying that the applicant has a disability that prevents them from using fixed route bus service. This information will be used to determine if the applicant qualifies for Demand & Response (Paratransit) service (Curb-to-Curb) or is able to use fixed route service for some or all travel.

Under the Americans with Disabilities Act (ADA) if a person has the functional and cognitive ability to use Carroll Transit System fixed route system, the applicant is not eligible for paratransit services. Disability alone, distance to and from the bus stop, or the availability of fixed route city bus service, is not by itself a qualifier for paratransit

All of the Carroll Transit System Fixed Route and Demand & Response vehicles are equipped with wheelchair lifts or ramps for individuals utilizing wheelchairs or by individuals unable to use the steps Carroll Transit System also offers Travel Training to assist persons with disabilities to use the fixed route bus service.

If you have any questions completing Part B, please call 410-363-0622

Minimum State Licensed or Certified Health Professionals

Certified Nurse Practitioner
Licensed Clinical Psychologist
Optometrist (visual disabilities only)
Physician

Physician Assistant
Podiatrist (foot and ankle disability only)
Psychiatrist (psychiatric disability only)
Registered Nurse

Print Applicants Name

A Licensed/Certified health Care Professional with knowledge of the applicant's functional abilities must complete this form.

Required Licensed/Certified Health Care Professional Information.

Name

Professional Title

Professional Specialization

Professional License Number

Clinic or Agency

Address

Street Address Line 2

CityState

Zip

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Fax

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Please include all applicable information in order not to delay the applicant's application.

What is the formal diagnosis of the applicants condition?

Does the applicant have specific behavioral problems?

Describe

Is the applicant able to travel alone?

Does the applicant have the ability to follow directions? (check one)

Would the applicant know what to do if they became lost out in the community?

Would the applicant be able to recognize and avoid dangers they might encounter when traveling in the community?

Does the applicant have the ability to safely cross streets?

Please check all that apply to safely cross streets at intersections. Provide additional information.

Is the applicant’s ability to travel outside alone affected by other conditions, such as environmental noise and ability to distinguish traffic flow patterns?

Explain:

With training could the applicant independently travel and use county bus service?

If no, explain:

How far can the applicant properly operate a wheelchair and/or ambulate with or without a mobility aid without lengthy rest breaks?

Applicant can walk approximately City Blocks

How long can applicant wait at a bus stop with a bench and shelter?

Hours

Mins

How long can applicant wait at a bus stop without a bench and shelter?

Hours

Mins

Provide other vital information that will help the Agency make an appropriate eligibility determination.