ADA Reasonable Modification Request Form

Request Form

Name of Individual Requesting Modification

First Name

Last Name

Name of Passenger Wishing to Utilize Modification

First Name

Middle Name

Last Name

Address of Passenger Who Needs Modification

Street Address

Street Address Line 2

City

Zip Code

Email

Primary Phone

Secondary Phone

Describe any modifications to TARTA’s policies, practices, or procedures that may affect your ability to fully utilize the services offered: *

*

Please indicate the address where you will need the requested modification:

Modification Street Address

Modification Street Address Line 2

Modification City

Modification Zip Code

Going from A to B?

Let Us Help

Plan A Trip

View All Routes

Bus Service

All Routes

Riding Today?

Get Going

Real Time

Customer Service

Need Help?

Contact

Empowering people to make connections.