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Orange County Transportation Services ADA Paratransit Plan <br /> <br />Orange County Planning Department Page 36 <br /> <br />Travel distance limitations: <br />Limitations regarding time of day to travel: <br />Weather conditions: <br />Environmental conditions: <br />5. Please choose the statement below which best represents your opinion regarding this individual’s use of <br />public transportation: <br />☐This individual should be able to access public transportation successfully. <br />☐This individual can use public transportation under certain situations as stated above. <br />☐This individual cannot use public transportation due to multiple functional limitations. <br /> <br />Signature: <br />Print Name: <br />Date Signed: <br />Print Title: <br />Business Address: <br />City: Zip: <br />Phone: Fax: <br />Organization/Practice: <br />Type of Practice: <br /> <br />THANK YOU FOR YOUR ASSISTANCE! <br /> <br /> <br />FOR OCTS USE ONLY <br />APPROVED ☐ DENIED ☐ <br /> <br />ISSUED BY TITLE <br /> <br />DATE FILE NUMBER <br />46