Public Transit Travel Training Request Form

Gender
Do you want to learn to ride the bus or the train?
Where will you go by using the bus or train? (Check all that apply)
Have you ever ridden a bus or train before?
List the cities or locations that you’d like to visit using public transit.
Do you currently have a Clipper Card?


Click here to Get a Clipper card.


I have a regular adult Clipper Card

Check box if you have regular adult Clipper Card


I have a Senior Clipper Card (age 65+).

Check box if you have a Senior Clipper Card (age 65+)
How do you currently get around?
Is there a bus stop near where you live?
Can you walk to the stop?
Is there a train station near where you live?
How long can you comfortably walk or travel before needing a break?
Which of the following do you use (check all that apply)?


Who is Your Emergency Contact?

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