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City of Billings - MET Transit MET-PLUS 1705 Monad Rd I Billings, MT 59101 (406) 657-8218 I Fax (406) 657-8419 www.METTRANSIT.com MET-PLUS Paratransit Application 1. Eligibility Questionnaire This form must be completed by the applicant or someone authorized to sign on the applicant’s behalf. 2. Professional Verification Form All applicants must sign the Authorization for the Release of Information included in Part 2, page 1. The remainder of the form must be completed by a professional who is familiar with the applicant’s condition and qualified to respond (see right). 3. Submit Both Forms Together Submit both the Eligibility Application and the Professional Verification together. All applications will be processed within 21 calendar days of receipt of the completed packet and the applicant will be notified in writing of MET’s determination of eligibility. 4. Avoid Delays in Application Process • All pages for both forms must be submitted • Check that all questions have been answered • Make sure all needed signatures are present • Double check the professional credential section is complete An incomplete application will be returned to the applicant one time with a notice of what is missing. If it is returned to MET-PLUS Paratransit incomplete a second time, the applicant will be sent a new blank application to complete. List of Qualified Professionals: • Physician or • Physical Therapist • Physician Assistant • Licensed Clinical Social Worker (LCSW)(LCPC) • Occupational Therapist • Nurse Practitioner • • Certified Orientation and Mobility Specialist • Speech/Language Pathologist MET recognizes many professionals work with clients with disabilities and the list above is not meant to exclude those professionals. In general, professionals who have completed a multi-year degree program and/or are licensed by the State of Montana will suffice. A primary care physician is often able to adequately complete this form. You do not need to visit a specialist. Follow-Up Information The eligibility of most applicants can be determined by the forms submitted to MET Transit staff. However, there may be cases where MET contacts the applicant or representative for more information regarding an applicant’s disability. This contact may include, but is not limited to questions and information as follows: • A conversation about the applicant’s mobility • Reading a bus schedule to plan out a bus trip • Setting up Fixed-Route Travel Training • Requests for further professional evaluation If follow-up information is necessary, your application will still be processed within 21 calendar days of receipt. Transportation will be provided. Updated July 2025 ---PAGE BREAK--- MET-PLUS Paratransit Eligibility Application Page 1 1 Part 1 Eligibility Application Complete the entire application. Incomplete applications will be returned. Check this box if someone other than the applicant is completing this form and provide the following information Legal Guardian Information First Name Last Name Middle Initial Street Address Apartment # City State Zip Code Home Phone ( ) Mobile Phone ( ) Relationship to Applicant (Family Member, Case Worker, etc.) In case of emergency, who should we contact? Who is authorized to contact MET on your behalf? Emergency Contact Name Contact Name 1 (Individual or Organization) Primary Phone ( ) Phone ( ) Secondary Phone ( ) Contact Name 2 (Individual or Organization) Relationship Phone ( ) Is this a new application, or a recertification? New Recertification Applicant Information First Name Last Name Middle Initial Street Address Apt. # City State Zip Code Is this an apartment complex, mobile home park, or facility? Yes No Name of complex or facility Home Phone ( ) Mobile Phone ( ) Sex Male Female Date of Birth (mm/dd/yyyy) Primary Language English Other Certification:________________ Pronoun Preference_______ ---PAGE BREAK--- MET-PLUS Paratransit Eligibility Application Page 2 A General Information How long would you like to use the service? Temporarily Permanently (Recertification is required every 2 years) What is your current primary transportation option? Walking Taxi Drive myself Fixed Route Bus MET-PLUS Paratransit Other, specify: Ride with somebody Bicycle Can you use the fixed route bus without someone else’s help? Yes, I currently ride the Fixed Route Buses No, I have never ridden. I only ride with assistance from others. I do not ride anymore I only ride when the bus stops are accessible. MET Transit provides free, in-person training to help you learn to ride our Fixed Route Buses. Would you be interested in this service? No Yes Possibly, please contact me. Do you require a Personal Care Attendant to travel with you? No Yes Sometimes, Do you travel with a Service Animal? No Yes, Type: B Mobility Information and Capabilities What mobility device(s) will you be using? (Note: Larger mobility devices and devices that exceed 600 pounds when occupied may exceed equipment transport capacity.) Cane White Cane Manual Wheelchair Crutches Prosthesis Powered Wheelchair or Scooter Walker Portable Oxygen No aid required What is your estimated bodyweight? lbs. ---PAGE BREAK--- MET-PLUS Paratransit Eligibility Application Page 3 Are you able to complete the following tasks without assistance from another person? Check a box for each question. If you answer sometimes for any questions please explain. A. Get to/from a bus stop? Always Never Sometimes B. Walk or travel using a mobility device for 3 blocks? Always Never Sometimes C. Get on/off a fixed route bus without using the lift or ramp? Always Never Sometimes D. Get on/off a fixed route bus using the lift or ramp? Always Never Sometimes E. Climb three 10-inch steps? Always Never Sometimes F. Wait at a bus stop while standing for 15 minutes? Always Never Sometimes G. Wait at a bus stop while sitting for 15 minutes? Always Never Sometimes H. Maintain your balance entering, exiting, and riding a fixed route bus? Always Never Sometimes I. Understand and follow verbal directions? Always Never Sometimes J. Recognize correct stops and landmarks to complete a trip? Always Never Sometimes K. Hear stops announced by the operator or onboard speakers? Always Never Sometimes L. Read and follow informational signs? Always Never Sometimes M. Plan a trip using a bus schedule? Always Never Sometimes N. Clearly communicate information about yourself? Always Never Sometimes Please explain any boxes checked Sometimes: C Disability Information These questions help describe your disability and how it may impact you. What is your disability? Is your disability: Permanent Stable Progressive Temporary, how long? Months_______Years______ ---PAGE BREAK--- MET-PLUS Paratransit Eligibility Application Page 4 Explain how your disability prevents you from the following: Please provide a complete and specific answer. Attach an additional page if needed. Getting on or off a lift/ramp equipped Fixed Route Bus; and/or Getting to or from a bus stop; and/or Successfully completing a bus trip How far can you travel on level ground? (With your mobility aid, if any.) Less than one block Two blocks Three blocks Four blocks or more Can you, with a mobility aid if needed: Yes No Yes No Move yourself from your threshold/door to the street curb? Wait at the street curb for a ride? Wait at the front door/lobby for your ride? Yes No (Note: MET Transit operators are not allowed to cross the outer threshold/door of any residence, facility or business.) Does your disability prevent you from using Fixed Route service seasonally? No, my inability to ride is not weather related. Yes, I can only ride Fixed Route Buses in the summer. Yes, I can only ride Fixed Route Buses in the winter. Does your disability change daily in ways that could disrupt your ability to use Fixed Route Bus service? No Yes, please explain: ---PAGE BREAK--- Mountain Line Paratransit Eligibility Application Page 5 Please list three trips you frequently take: Starting Address Ending Address 1. 2. 3. D Application Signature I understand the purpose of this application is to determine if the applicant is eligible to use MET-PLUS ADA Paratransit Service. I certify the information provided in this application is true and correct. I understand that falsification of information could result in the denial of ADA Paratransit services as well as a penalty under local, state and federal law. I agree to notify MET-Transit if my circumstances change and I no longer need to use ADA Paratransit Services. I understand that I am responsible for authorizing a Professional Verification of my condition(s). I also understand that a follow-up conversation, an informational meeting or further assessment by a professional may be requested. Applicant or Guardian Signature: Date: Part 1 Completed. The following pages must be sent to your Health Care Provider after you complete section 2, page 1, Information Release. SIGN ---PAGE BREAK--- MET-PLUS Paratransit Professional Verification Page 1 2 Part 2 Professional Verification Complete the entire application. Incomplete applications will be returned. Information Release Medical Information / HIPPA Authorization I, authorize the healthcare provider (listed below), and their office completing this application to release to MET Transit any protected health information about my disability in order to verify my eligibility for Paratransit service. I also authorize the release of further information should it be needed for this application for a period of 60 days from the date of my signature on this application unless revoked in writing. Applicant Signature Date Applicant Name (printed) Date of Birth Your Health Care Provider Health Care Provider Provider Profession Address Phone Fax The following pages must be filled out by your Health Care Provider. SIGN ---PAGE BREAK--- MET-PLUS Paratransit Professional Verification Page 2 Dear Healthcare Professional: The patient listed on the accompanying release form is applying for MET Transit MET-PLUS Paratransit Service. The information you provide in answering the questions on the enclosed questionnaire will aid MET in making a Paratransit eligibility determination. Please keep in mind this document is time sensitive. Because demand for this service is high, qualification criteria are stringent. For the benefit of the applicant, please answer all of the questions completely and accurately. Please return completed questionnaires to the applicant so the applicant can return the completed packet to MET. In accordance with Americans with Disabilities Act (ADA) guidelines, Paratransit service is available only for persons who have disabilities that prevent them from traveling on Fixed Route Buses. The individual could be prevented by inabilities to independently get to and from a bus stop, on or off a bus, or to successfully navigate to a destination. Please keep in mind ADA Paratransit eligibility is not based on age, a medical condition, the inability to drive, or the use of a particular mobility aid. The severity of a disability does not confer eligibility. Comfort and convenience are not factors. ADA Paratransit eligibility is based on the EFFECT a disability has on the client's ability to use the regular MET Transit lift and ramp equipped Fixed Route Bus system. All information provided will remain confidential. If you have any questions, please call (406)657-8218. Thank you for your assistance, MET Transit MET-PLUS Paratransit Services City of Billings - MET Transit MET-PLUS 1705 Monad Rd I Billings, MT 59101 (406) 657-8221 I Fax (406) 657-8419 www.METTRANSIT.com ---PAGE BREAK--- MET-PLUS Paratransit Professional Verification Page 3 A General Disability Questions Describe the diagnosed disability or disabilities you are currently treating this individual for: Check all that apply Is the patient’s disability: Permanent Stable Progressive Temporary - How long? Months_____Years____ Does your client’s disability: Affect mobility Affect judgment Require use of a mobility aid Require them to have assistance when traveling outside their residence Can your client: A. Travel 3 blocks (1,000 feet) with their mobility aid? Yes No B. Climb three standard steps without assistance? Yes No C. Stand without support for 15 minutes? Yes No D. Walk or stand without debilitating pain or discomfort? Yes No E. Board or de-board a fixed route bus equipped with a lift or ramp? Yes No F. Recognize correct stops and landmarks to complete a trip? Yes No G. Hear and understand verbal information? Yes No H. Read and understand informational signs? Yes No I. Plan a trip using public transportation? Yes No J. Communicate information about themselves? Yes No (checking this box means the client cannot travel safely without a PCA) ---PAGE BREAK--- MET-PLUS Paratransit Professional Verification Page 4 B Disability Specific Questions Please only complete those questions that apply to the applicant for this section. Does the applicant experience seizures? No Yes Is the applicant’s judgment impaired? No Yes Does this condition affect the applicant’s ability to move independently outside their residence or a supervised environment? No Yes Does the applicant experience any hallucinations, delusions, or disassociation? No Yes Does this prevent the applicant from being oriented to person, place, & time? No Yes Please describe any triggers that may cause disorders to manifest. Please describe the functional limitations caused by this impairment. ---PAGE BREAK--- MET-PLUS Paratransit Professional Verification Page 5 C Mobility and Safety Questions Does the applicant have a visual impairment that affects their ability to move about in the environment? No Yes If yes, please explain: Has the applicant received any orientation & mobility training? No Yes If yes, please explain: Please list any side effects of medication the applicant experiences that could affect transporting them safely. Would you like to add any additional comments on the functional ability of the applicant? ---PAGE BREAK--- MET-PLUS Paratransit Professional Verification Page 6 D Provider Affirmation Provider Information Address Phone Fax City State Zip code Provider UPIN # or Tax ID Employer / Agency Provider Signature and Affirmation I am a licensed medical provider or qualified service provider and certify that the above mentioned individual has the disability and limitations indicated above. Provider Signature Date Provider Name (printed) Part 2 Completed. SIGN ---PAGE BREAK--- MET-PLUS Paratransit Professional Verification Page 7 3 Part 3 Submit Both Forms Together Complete the entire application. Incomplete applications will be returned. Make sure all questions have been answered, and required signatures are in place. Submit both the Eligibility Application and the Professional Verification Form. Mail to: MET Transit MET-PLUS 1705 Monad Rd. Billings, MT 59101 Fax: (406) 657-8419 You may also submit all forms in person at the address above, M-F, 8:00 am – 5:00 pm or email the forms to All applications will be processed within 21 calendar days of receipt of a completed packet and the applicants will be notified in writing of MET Transit’s determination of eligibility. Follow-Up Information You will be contacted if follow-up information is required. If so, your application will still be processed within 21 calendar days of receipt. Transportation will be provided. Thank you for completing the MET-PLUS Paratransit Application. Please make sure all questions have been answered, signatures gathered, and both forms are included in your submission. We look forward to serving you. Print Form