City Program Application Form
Please use this application if you are a resident of: Alameda, Albany, Berkeley, Castro Valley, Emeryville, Fremont, Hayward, Newark, Oakland, Piedmont, Pleasanton, San Lorenzo, or San Leandro.
Applicants from Union City should apply through Union City Paratransit.
Applicants from Dublin and Livermore should apply through Wheels Dial-a-Ride.
ADA paratransit service operators (East Bay Paratransit, Union City Paratransit & Wheels Dial-A-Ride) require a separate application process.
Some cities may require additional documentation, please contact your city. Question 16 offers you the chance to upload documents.
This application will be sent to the appropriate program based on the city you choose in the home address section below. Upon receipt of this form, the program may contact you to submit additional information.