Grant Application for Bus Passes/Tickets for Nonprofit Organizations and Government Agencies

Section 1: Organization Information

Type of Organization

Please select one from the drop down option.

State

Please select one from the drop down option.

Primary Contact Name

First and Last Name

Section 2: Program Details

Describe the program or service for which you are requesting bus tickets.

Briefly describe how the bus tickets will be used and the population served (e.g., transportation for homeless individuals, transportation for job training, etc.)

Frequency of Transportation Needs

How often do you expect individuals to use bus tickets?

Please select one

Daily

Weekly

Monthly

Other (specify)

How will the bus tickets directly benefit your clients or program participants?

Explain how bus tickets will help imporove access to essential services, education, employment, or other benefits for your clients.

Section 3: Pass and Ticket Request Details

Monthly Pass Type(s) Requested

Please select all that apply.

10-Ride Ticket Type(s) Requested

Please select all that apply.

Specific Routes or Areas of Service:

Please specify if your program requires bus tickets for specific routes, transit systems, or geographic areas.

How do you plan to distribute or manage the tickets within your organization?

Describe your internal process for distributing tickets to clients and ensuring tickets are used appropriately.

Section 4: Eligibility and Certification

I confirm that the Organization listed in this application is a registered nonprofit or government entity.

I confirm that the requested tickets will only be used for services directly related to the mission of the Organization listed in this application and not for personal use.

Do you receive funding from other sources for transportation?

Please select one.

Yes

I certify that the information provided in this application is accurate and complete to the best of my knowledge.

I understand that the misuse of bus tickets may result in the revocation of ticket privileges for our Organization.

I agree to provide periodic reports or updates on how the tickets were used as required by the transit agency.

Signature of Authorized Representative

Please type your name below in ALL CAPS to sign this form. By signing this form, you confirm you understand and agree with all items in Section 4: Eligibility and Certification above.

File Upload

Please upload any documents that will help with the approval process for this Grant Application.

Drop your files here