Application for ADA Paratransit & Specialized Transit Services

Thank you for choosing Metro Connection for your transportation needs. Metro Connection, a division of Shoreline Metro, provides ADA Paratransit and Elderly and Disabled Transportation for eligible and certified customers! The application below if the first step to ensuring your independence!

Applications will be reviewed in a timely manner. A letter of determination will be sent to the applicant within 21-days of receipt of the completed application. Any incomplete or inaccurate applications may delay the certification process. Submission of this application does not guarantee eligibility.

Questions or comments regarding the application or to request the application in an alternative format, please contact Metro Connection at (920) 459-3281, Option 2. To translate this application, please click the “Translate” button in the lower right of this page.

DIRECTIONS: Application is a fillable form. Please fill out the application completely and accurately. Fields marked with an * are required. Press the “Submit” button once application is complete. The application submits electronically to Shoreline Metro for review and consideration. You will receive a confirmation response if the application was submitted successfully.

This is the date the application was submitted.
Customers are able to schedule trips, receive trip alerts, view their bus, make payments and cancel trips using the Metro Connection On-Demand app. Customers must have a smartphone, tablet or personal computer in order to access these features. For more information, visit the Schedule a Trip page under the Metro Connection menu at www.shorelinemetro.com.
Required if you answered YES to the previous question. If you answered NO, please put N/A in the field.
Otherwise known as Title XIX or MA (not to be confused with Medicare)
Please check all that apply.
Please check all that apply.
Please check all that apply. The Americans with Disabilities Act (ADA) requires public transportation programs to service those individuals in a mobility device if the lift and vehicle can physically accommodate the passenger. If accommodations become inconsistent with legitimate safety requirements, the ADA does not guarantee your trip. This clause is observed by all specialized and non-specialized transportation services provided by Shoreline Metro.
2-3 city blocks equals 1/4 mile.
This means without the need or requirement to sit.
Cognitive is defined as ability to perceive and react, process and understand and make decisions and produce responses.
Please describe how your disability impacts your ability to travel and use public transportation.
Please indicate the level of assistance that is required in order for you do daily activities.
Shoreline Metro is the fixed route, public transit service with bus stops available on all corners along each route.
Shoreline Metro is the fixed route, public transit service with bus stops available on all corners along each route.
Please do not use abbreviations or acronyms. Be specific.
Personal care attendants may ride at no additional charge. Customer must provide the personal care attendant.
Please check all that apply.
Personal Care Attendant #1
Personal Care Attendant #2
This will help us determine the appropriate program especially if the applicant is over the age of 60.
In order for your application to be evaluated, it may be necessary to contact a physician or other professional to confirm the information you have provided. The following professional(s) is most familiar with my disability/health condition and is/are authorized to provide Metro Connection with the information required to complete this certification.
Please include address, facility, and phone number.
Once complete, scroll down and press the SUBMIT button.

The Shoreline Metro ADA Coordinator will be in contact shortly regarding your application. Upon completion of this application, Shoreline Metro may 1) request additional information from a medical profession, 2) schedule an in-person home assessment, or 3) schedule an evaluation using Shoreline Metro (city bus).

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