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Orange County Transportation Services ADA Paratransit Plan 36 <br /> and note whether your condition is temporary or permanent and if it is episodic in nature (i.e. do you <br /> have "good days" or times when you can access transportation and "bad days" when you cannot?) <br /> (OTH) <br /> The condition is ❑temporary ❑permanent <br /> -------------------------------------------------------------------------------------------------------------------------------- <br /> ❑I am declining with functional losses due to aging. I feel I am not able to access regular bus service <br /> due to the following limitations: (OTH) <br /> The condition is ❑temporary ❑permanent <br /> -------------------------------------------------------------------------------------------------------------------------------- <br /> ❑My functional limitations do not fit into any of the above categories. I am unable to use regular bus <br /> service because: (OTH) <br /> The condition is ❑temporary ❑permanent <br /> -------------------------------------------------------------------------------------------------------------------------------- <br /> ❑Are you involved in any programs or training which will have an impact on your ability to use <br /> public transportation? If so,please describe. <br /> TRANSPORTATIONS NEEDS, ENVIRONMENTAL OR INDIVIDUAL FACTORS <br /> Do you currently use any regular fixed-route bus services? ❑Yes ❑No <br /> If yes, which routes? <br /> Can you get to the bus stop by yourself? ❑Yes ❑No <br /> If no, what limits you from getting there? <br /> Please check a_y of the following which are applicable to your situation. <br /> If I am waiting outside at a bus stop, I must have: <br /> ❑a bench El shelter ❑nothing additional <br /> When crossing a street, I need: <br /> ❑curb cuts ❑tactile curb warnings ❑audible signals <br /> Orange County Planning Department Page 30 <br />