LED<\/p>\n
=<\/p>\n
Laguna Woods Village<\/p>\n
Journey Bus Rider<\/p>\n
Laguna Woods Village<\/p>\n
Dear Laguna Woods Village Resident:<\/p>\n
All Laguna Woods Village residents requesting Journey bus service are required to complete an<\/p>\n
application process.<\/p>\n
As part of the application process, professional assessments will be completed for all Journey bus<\/p>\n
riders by experienced health care professionals.<\/p>\n
All riders must make a reservation for their assessment. Call Transportation at 949-597-4659 to<\/p>\n
schedule an appointment.<\/p>\n
A bus or van will pick you up from your manor. The assessment takes approximately 30 minutes.<\/p>\n
When the assessment is complete, we will transport you home. We anticipate you should be home<\/p>\n
within an hour.<\/p>\n
Enclosed is the application form all applicants must complete. Read the application guide on the first<\/p>\n
page and fill out the questionnaire that follows. Bring the completed form with you to your<\/p>\n
assessment appointment. The certification analyst will review the application with you at that time.<\/p>\n
The application process is done at no cost to you, and all information will be kept confidential and<\/p>\n
will not be released without your consent.<\/p>\n
If you cancel the assessment appointment or fail to appear, you will not be eligible to reapply for six<\/p>\n
months.<\/p>\n
The results of the assessment will be made available to you as soon as possible, but it may take up to<\/p>\n
14 days.<\/p>\n
Sincerely,<\/p>\n
Laguna Woods Village Transportation Department
\nI<\/p>\n
va<\/p>\n
Laguna Woods Village<\/p>\n
LAGUNA WOODS VILLAGE JOURNEY APPLICATION GUIDE<\/p>\n
There is no cost to apply or complete the certification process.<\/p>\n
sept<\/p>\n
<\n\nPlease call Laguna Woods Village Transportation at 949-597-4659 to request an application and schedule an\n\nin-person assessment.\n\nReceive a complimentary paratransit ride to the certification site.\n\nComplete the application BEFORE you arrive to your assessment.\n\nPlease sign and date the application.\n\nAll information will be kept confidential and will not be released without the consent of the applicant.\n\nSep2\n\n<\n\nParticipate in an in-person functional assessment. This assessment is not a physical. It measures the skills\n\nnecessary to board, ride, disembark and understand the public bus.\n\n<\n\nYou may bring one person with you to the assessment at no cost.\n\n<\n\nEligibility determinations are categorized as follows:\n\nUnrestricted eligibility:\n\nIndividuals who are functionally unable to board, ride, disembark or understand the fixed-\n\nroute bus system. Individuals who are granted unrestricted eligibility may take any eligible\n\ntrip on LWTS for five years.\n\nTemporary eligibility:\n\nIndividuals whose disability may improve over time.\n\nIneligible determination:\n\nIndividuals, who indicate or demonstrate they have the functional ability to board, ride,\n\ndisembark and understand the fixed-route bus system under all circumstances.\n\n<\n\nUpon completion of the in-person assessment you will receive an eligibility notification letter within 21 days.\n\n<\n\nThis letter will inform you of the results of your eligibility determination.\n\n<\n\nIf you do not agree with the eligibility determination, you may appeal the decision within 60 days of the eligibility\n\nnotification postmark.\nva-\n\nLaguna Woc as Village\n\nLAGUNA WOODS VILLAGE PARATRANSIT APPLICATION\n\nLast:\n\nFirst:\n\nMI:\n\nAddress:\n\nState:\n\nCity:\n\nZip:\n\nMailing Address:\n\nCity:\n\nState:\n\nZip:\n\nDay Phone:\n\nEvening Phone:\n\nYES\n\nNO\n\nYES\n\nNO\n\nTDD (Hearing impaired)\n\nTDD (Hearing impaired)\n\nDate of Birth:\n\n[SECTION 2: EMERGENCY CONTACT INFORMATION\n\nName:\n\nRelationship:\n\nAddress:\n\nCity:\n\nState:\n\nZip:\n\nDay Phone:\n\nEvening Phone:\n\nA\n\nWhat is your diagnosis? (Please describe your disability; if visually impaired, indicate acuity)\n\nB\n\nWhat is your prognosis? (Please check the box that most accurately describes your disability)\n\n[| Permanent\n\n[|] Temporary [_]Improving [_|Terminal\n\nCc\n\nWhat is your treatment plan? (Please include time frames)\ni\n\nLaguna Woods Village\n\nCheck the box that most appropriately applies to your ability to independently perform the following skills\n\nALWAYS\n\nSOMETIMES NEVER\n\nUnderstand how to take a trip on a public bus\n\nRecognize bus route numbers\n\nRecognize landmarks (church, fire station or street signs)\n\nHold on to a handrail\n\nBreathe without difficulty\n\nUse a telephone\n\nTransfer from a sitting to a standing position\n\nMaintain balance\n\nClimb three 10-inch steps\n\n10. Walk or wheel independently\n\n11. Wait at a bus stop for 20 minutes\n\n12. Cross streets\n\n13. Shop in a grocery store\n\nA\n\nHow does your disability affect your ability to travel?\nf\n\nLaguna Woods Village\n\nB\n\nWhen was the last time you independently used the public\/Laguna Woods Village bus system?\n\n[] Within the past week\n\n[] Within the past month\n\n[] Within the past year\n\n[] Within the past 5 or more years\n\nCc\n\nHow many blocks are there from your residence to the nearest Laguna Woods Village bus stop?\n\n[ ]o-3\n\n[4-7\n\n[]8-11\n\n[12-15 [ ]Greaterthan 1 mile [_]Do not know\n\nD\n\nCan you independently travel from your residence to your nearest Laguna Woods Village bus stop?\n\nves ()\n\nNO O Please check the box(es) of the barrier(s) that prevent(s) you from accessing your nearest bus stop:\n\nCurb(s) or uneven surface(s) [] Hill(s) []\n\nNight blindness |_|\n\nLight sensitive LC\n\nUnable to cross intersection(s)__ Bus stop not accessible []\n\nOther:\n\nE\n\nDo you currently use a mobility device when traveling?\n\nno (OO)\n\nPlease circle:\n\nYES\n\nElectric wheelchair\n\nManual wheelchair\n\nScooter\n\nWalker\n\nSport wheelchair\n\nService animal\n\nProsthesis\n\nCane\n\nCrutches\n\nOther:\n\nF\n\nHow many blocks can you walk \/ wheel independently?\n\n[ 18-15\n\n[Jo\n\n]1-3\n\n4-7\n\n[| Greater than 1 mile\n\n[] Do not know\nf\n\nLaguna Woods Village\n\nIs your wheelchair and\/or scooter (if applicable)\n\nWider than 30 inches\n\nYES [|]\n\nOr longer than 48 inches\n\nves [|\n\nNO |]\n\nNO [|\n\nNOT APPLICABLE |__|\n\nNOT APPLICABLE |_|\n\nIs the total combined weight of you and your mobility device more than 600 pounds? (if applicable)\n\nYES [|\n\nNO |]\n\nNOT APPLICABLE [|\n\nDo you require a personal care attendant (PCA) when traveling on the Laguna Woods system?\n\nYES\n\nExplain:\n\nNO\n\nSOMETIMES\n\nExplain:\n\nPlease indicate which BEST describes the condition of your mobility (mark only one box):\n\nSeverely limited under all circumstances LC]\n\n| have good days and bad days []\n\n| can only go to specific locations ]\n\n| am currently receiving treatment and | hope to improve []\n\n| am able to travel independently under all circumstances []\n\nOther, please describe:\nLaguna Woods Village\n\nThank you for your interest in Paratransit service. We appreciate your time in completing this application. This\n\ninformation will be used to determine an accurate understanding of your functional abilities as they relate to\n\ntraditional public transportation systems.\n\n| understand if the paratransit provider receives new information regarding a change in my functional ability, my\n\neligibility status may be reviewed and changed. | understand the paratransit provider will notify me in writing of any\n\nchange in my eligibility status and | may appeal such decision within 60 days of notification.\n\n| hereby certify that the information on this form is true and correct to the best of my knowledge. | understand that\n\nmisrepresentation on this form or presented during my assessment may result in denial of privileges to use\n\nparatransit services. | understand that specific medical information that | and \/ or my physician and\/or healthcare\n\nprovider releases are confidential and will be protected. However, in the event that | am found eligible, | grant\n\npermission to the transit agency providing paratransit service to share information with transit providers that relates\n\ndirectly to my travel needs.\n\nFailure to sign the form will result in application being returned for completion. If applicant is unable to sign, please indicate below.\n\nSECTION 7: SIGNATURE\n\nApplicant or guardian signature:\n\nDate:\n\n<\/p>\n","protected":false},"author":2,"featured_media":0,"template":"","document_category":[1059],"document_type":[53],"class_list":["post-17361","document","type-document","status-publish","hentry","document_category-transportation","document_type-other"],"acf":{"document":67805,"resolutions":null,"legacy_id":"","pdf_extracted_text":""},"yoast_head":"\n