GAP provides rides for individuals who are certified as eligible for
paratransit service under the rules of the Americans with Disabilities
Act (ADA), because of their disability, are unable to use Greenlink
Transit, fixed route bus service.
GAP provides comparable service to the regular fixed route bus in terms
of shared rides, curb-to-curb pickup, service area, and days of service.
All riders must pay a fee. GAP fare is $3.00 each way. The driver cannot
make change. You must have the exact fare ready in cash or check when
you board the vans.
All individuals applying for GAP must complete the attached application.
Applicant must fill out the first two pages and the last page must be
completed by the applicant’s physician. Please return application either
by mail or fax.
If you have any questions or concerns you may contact me at the number
below.
Catherine Morgan
864-467-2759
[email protected]
For GAP use only
Date Received: _______________ Received by: __________________
GAP
Greenville Area
Paratransit
Greenlink  100 W. McBee Ave.  Greenville, SC 29601  ph 467-2759  fax 467-3387
To qualify for Greenville Area Paratransit (GAP) services you must fill out an application.
The first part is for the applicant and the second part is for a health care professional.
Send both completed forms to the above address. The information obtained from this
registration packet will be used by GAP personnel to determine eligibility for
complementary Paratransit services or medical transportation services.
Presumptive eligibility is granted 21 days after receipt of completed application.
(Please print or type all information)
1.
Name________________________________________________
2.
Street Address _____________________________Apt. _______
3.
City ____________________ Zip code ____________________
4.
Phone numbers:
Home ________________________
Work ____________________ TDD ______________________
5.
Nearest intersection to your residence:
_____________________________________________________
6.
What is your disability? ________________________________
7.
Is your disability temporary?
Yes ___ No ___ If yes, expected duration? _____________
8.
Please check each mobility aid that you use:
Manual wheelchair ____
Cane
____
Electric Wheelchair ____
Crutches ____
Powered scooter
____
Walker
____
Service Animal
____
White Cane ____
Rev. 6/11/09
9.
With or without a mobility aid, how far are you able to travel
without the assistance of another person?
Less than 200 feet
¼ mile (3 blocks)
____
____
½ mile (6 blocks) ____
¾ mile (9 blocks) ____
10.
Are you able to climb three 12-inch steps without the assistance of another
person? __________
11.
Are you able to wait outside without support for up to 15 minutes?
__________
12.
Are you able to grip a handrail to support yourself? _______
13.
Will a personal care attendant be riding with you on your trips?
___________
Please tell us anything else about your disability you feel we need to know
in order to help determine your eligibility.
Signature or mark: _____________________________________________
If signing with mark, witness signature: ___________________________
Date: _________________________
For assistance completing this application, please call the GAP offices at
467-2759
Rev. 6/11/09
For GAP use only
Date Received: _______________ Received by: __________________
GAP
Greenville Area
Paratransit
Greenlink  100 W. McBee Ave.  Greenville, SC 29601  ph 467-2759  fax 467-3387
***This Section Must be Filled out by a Health Care Professional***
The applicant named below is applying for the curb-to-curb van service provided by Greenville Area Paratransit
(GAP). In order to qualify for this transportation service, the applicant must be functionally unable to ride the
standard fixed route bus service currently provided by the Greenville Transit Authority, dba Greenlink. In order to
ascertain your client’s eligibility, we are asking that you complete this simple form and return it to the client. The
client cannot be considered for GAP services without this form. PLEASE NOTE: The person completing this
section of application must be medically trained (Example: Doctor or Nurse).
Applicant:___________________________________________________________________________
Name of Health Care Professional ______________________________________________________
Name of Facility or Agency___________________________________________________________
Address____________________________City_________________ State_____ Zip Code_________
Phone __________________________________
Fax ______________________________
Signature___________________________________Title_________________________________
1.
What is the applicant’s disability?___________________________________________________
(Please be specific)
2.
Is this disability temporary?
Yes______
No______
3.
Does the applicant require an attendant while traveling? Yes______
4.
With or without a mobility aid, how far is the applicant able to travel without the assistance of another person?
Less than 200 feet ____
½ mile (6 blocks)
____
¼ mile (3 blocks)
____ ¾ mile (9 blocks)
____
5.
Is the applicant able to climb three 12-inch steps without the assistance of another person? yes___ no ___
No________
(NOTE: All Greenlink Vehicles are Wheelchair accessible)
6.
Is the applicant able to wait outside without support for up to 15 minutes? __________
7.
How does the disability affect the applicant’s mobility? ___________________________________
8.
Does disability prevent applicant from using current bus system? Yes______ No_______
If yes, how does the disability prevent applicant from using current bus system:
____________________________________________________________________________________________
For assistance in completing this application, please call the GAP office at 467-2759. Forms not completely filled out may prevent
applicant from being certified for GAP service.
Rev. 6/11/09