Fare Assistance Program - VIA Metropolitan Transit

Fare Assistance Program

Application Form

Please submit the following application for the requesting organization.

Only 501(c)(3) non-profit, social service and governmental/public organizations in good standing located within the VIA service area serving clients who are low-income and/or living below the federal poverty level are eligible to apply for VIA’s Fare Assistance Program.

Fare Assistance Program

REQUIRED ATTACHMENTS

1. Include a copy of your Agency's IRS letter confirming 501(c)(3) eligibility as described by the Federal Internal Revenue Code
Drop a file here or click to upload Choose File
Maximum upload size: 52.43MB
2. Include a copy of your Organization Bylaws, Charter or Annual Report
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Maximum upload size: 52.43MB

ORGANIZATION DESCRIPTION

DESCRIPTION OF PROGRAM, FARE DISTRIBUTION AND USE

Your organization will be responsible for maintaining a log of clients receiving bus passes through VIA’s Fare Assistance Program. VIA will provide a document to participating organizations to record clients receiving passes and type of passes received. VIA may review the log quarterly to ensure that the passes purchased through VIA Fare Assistance Program comply with the purpose and intent of the program.
4. WHAT TYPE OF BUS PASSES DO YOU ANTICIPATE PURCHASING TRHOUGH VIA’s FARE ASSISTANCE PROGRAM? (PLEASE CHECK ALL APPLICABLE BOXES)

CERTIFICATION

Electronic Signature of applying organization’s authorized representative
Title
Date
Electronic signature of organization’s authorized Chief Executive Officer/President (if different from applying representative)
Title
Date