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Sun Van Application for Paratransit Service

If there are questions that you cannot answer or if you need assistance to complete this form, including alternative formats, please call 505-724-3100.

Please complete this application as thoroughly as possible and to the best of your ability. To be considered complete, every question on the application must be answered. If not, it will be returned to you for completion.

Applicant Information

Are you a new applicant?  

Are you recertifying?

Applicant Contact Information
About You

Emergency Contact Information
Healthcare Professional Contact Information
Disability & Health Condition Information
Does your disability PREVENT you from using the regular bus?  

Which of the following best describes your conditions?  

Does your disability change from day to day or seasonally?  

Do the conditions you describe change from day-to-day in a way that affects your ability to ride the regular bus service?  

Does your disability make it difficult for you to understand and remember how to find your way to and from the bus stop?

Mobility Information
Do you currently use any mobility aids or specialized equipment?  

If yes, please select all that apply.
Current Travel Information
How do you currently travel to your frequent destinations?   Please check all that apply. Check all that apply. Please explain more if you select Other.
Which of the following statements best describes you if you had to wait outside for a ride?   Choose one. Please explain more if you select that you need someone to wait with you.

Which of the following statements best describes your history of using regular bus service.   Choose one. Please explain more if you select that you have never used the regular bus service.

How far is your residence to the nearest bus stop?  

Applicant Certification
Authorized Representative Certification Please check the box and fill this section if this form was completed by an authorized representative.