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Low Income Fare Trips (LIFT) Program Application

  1. Gender*
  2. New or Renewal?*
  3. Reduced Fare*
  4. If Yes*
  5. Ethic Group
  6. Passes are limited to persons 18 years of age and older who meet the income requirements (must be below 150% of HHS Poverty Guidelines).  Passes are limited to 4 per person per month, not to be used on consecutive days, and are available on a first come, first served basis.

  7. Certification:

    I certify this application has been completed to the best of my knowledge with complete and accurate information.  I understand any false statements or omissions of facts relevant to my eligibility for assistance will be considered fraud, and that I may be prosecuted under applicable U.S. Codes for this fraud.  Furthermore, I understand that assistance is contingent upon availability of passes.  

  8. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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  10. This field is not part of the form submission.