Ridership Independence for the Disabled in Buncombe County

Eligibility

HOW TO APPLY

Other Transportation Options

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOW TO APPLY


Fill out and submit the form below, call (828) 250-6750 ext 5, or download the participant application.

Name:
Street Address:
City:
Zip Code:
Email Address:
Telephone Number:
Date of Birth:
Gender:
Last 4 Digits of SSN:
Emergency Contact  
Name:
Relationship:
Telephone Number:
Eligibility Criteria:
Assistance Needs: (Check all that apply)
Primary Language: