Request a Bus Buddy Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress *Address, City, State and ZIPPhone Number *Email *I need a Bus Buddy because (Please select all that apply) *I am new to the areaI do not know how to use the busI’m afraid or fearful of using the busI don’t have reliable transportationPlease tell us about your mobility (Please select all that apply) *I am ambulatory (walk on my own)I require the use of a mobility deviceI use a walker or a caneI require the use of a service animalI carry medical equipment with meI can travel up to 2 blocks on my ownI can travel 2+ blocks on my ownI currently reside in: *A single family homeAn apartment complexAn assisted living facilityIf you have a disability, please select all that apply: *PhysicalMental/CognitiveHearing/Vision/SpeechIncontinencePlease describe the locations you wish to travel: *Any other comments or concerns: *Submit