Tarta'S Reasonable Modification Appeal Form printable pdf download

Tarta'S Reasonable Modification Appeal Form

TARTA’S REASONABLE MODIFICATION APPEAL FORM

In determining whether to grant a requested modification, the Toledo Area Regional Transit Authority (TARTA) will be

guided by the provisions of the Americans with Disabilities Act (ADA) as amended and the United States Department of

Transportation (DOT) regulations in conjunction with the guidance provided in Appendix E of Title 49 CFR Part 37.

Name of individual requesting modification _____________________________________________

Name of individual wishing to utilize modification _________________________________________

Address of passenger who needs modification __________________________________________

City_________________________ State ________ Zip Code______________________________

Telephone Number (Home)___________________Telephone Number (Cell)__________________

Date modification requested__________________ Date modification denied_____________________

Reason for appeal________________________________________________________________

______________________________________________________________________________

This form may be dropped off in person at 1127 W. Central Ave.; mailed to TARTA Human Resources, 1127 W.

Central Ave., Toledo, OH 43610; or completed online at

For Office Use Only: __________ Date Received __________ To HR for evaluation

__________ Request Approved/Denied

___________ Response Issued __________ Notification sent

Tarta'S Reasonable Modification Appeal Form