HomeMy WebLinkAboutSenior_DAR_Application
The Senior Dial-A-Ride program is a shared-ride, demand response sedan or mini-van service.
This service is available to residents of the City of Oshkosh age 60 and over. It is a curb-to-curb
service that can be used for trips within the City of Oshkosh. To become eligible for this
program and obtain a required Senior Dial-A-Ride card, please complete the application below
and provide proof of age. You can bring the completed form and proof of age into our office or
complete the application online and your card will be mailed to you. Our office is located at 926
Dempsey Trail and our office hours are Monday – Friday from 8:00 am-4:30 pm, closed for
lunch 12:00 pm – 1:00 pm. Please review the GO Plus Senior Dial-A-Ride brochure for full
program information and details on scheduling your trips.
FIRST NAME: __________________________ LAST NAME: ______________________
ADDRESS: _________________________________ Oshkosh, WI ZIP CODE: __________
DATE OF BIRTH: _____________ PHONE NUMBER: ___________________________
PROOF OF AGE PROVIDED: ______________________________
I certify that, to the best of my knowledge, the information given on this application is
true and accurate. I understand that GO Transit will rely upon this information when
determining eligibility for the Reduced Fare Program. I understand that providing false
or misleading information will result in my eligibility being revoked. Allowing
individuals, other than myself, to utilize this card will also result in revocation.
Applicant’s Signature: _____________________________________ Date: ______________
Senior Dial-a-Ride Program Application
For Office Use Only
Date Issued: __________ Staff Initials: _______