In signing this application, I hereby give RTWA permission to share and/or verify all my information with other people and/or agencies as needed in their evaluation of my application.

I realize this does not guarantee my application will be accepted.
I will submit this application AT LEAST 7 DAYS BEFORE I need my first ride.
If employed (or pending), RTWA may call my supervisor to verify your employment
I agree to pay at the rate of $5/per day for transportation, no later than the Thursday prior to the week I plan to ride. I will pay this to South Main Chapel & Mercy Center. If I do not make the payments on time, I understand that I will NOT receive rides for the following week and I may be removed from the program.
I have read the Rider Rules and will sign the form in agreement with the rules.
I will work with my coach to create a Personal Budget and Action Plan.
I have read and will sign the liability waiver.
I attest that all information is true and current. If misrepresented I understand I may be ineligible to participate in the RTWA program.

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Application for Ride To Work Anderson

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