Step 4: Register as a WOTA Rider

The Main Application

WOTA requires that everyone who rides our vehicles complete an application. The Passenger Application is found below. If you are unable to complete the form online, please contact dispatch at (248) 887-4979.

WOTA has created a video demonstrate how you complete the registration form. You may find the video in the Video Library or below.

 

Do I need to fill out another form?

  • Professional Verification is for anyone with a disability.
  • Low Income qualification is for those that do not qualify for senior or disability but qualify for a reduced fare based on income.
  • Minor Consent is for low income families that have children riding for access to DHS services with their family member.

Passenger Application

Print Friendly Passenger Application
Passenger Application PDF

Please fill in the information below, sign and either submit the online form, or choose the printer-friendly application and email to: info@rideWOTA.org or mail to:  250 W. Livingston Rd.  Highland, MI 48357

This field is for validation purposes and should be left unchanged.
Today's Date(Required)
Address of Residence(Required)
Date of Birth(Required)
Disabled?(Required)

West Oakland Transportation Authority (WOTA) requires verification by a professional in order to qualify disabled individuals requesting service for transportation. Please use the Professional Verification form
Are you a food pantry client?(Required)

In Case of Emergency

Contact(Required)
Address(Required)

Companion Rider (18+ years)

Contact

Applicant Eligibility

Please select all that Apply(Required)
Please select all mobility devices that apply(Required)
NOTE: For Safety reasons, All Mobility Devices cannot be more that 33 inches wide and/or be more that 1,000 lbs INCLUDING the Passenger while on the lift.
I certify that the above information is correct and the address is where I reside, And I understand that submitting false information is just cause for refusal of service.(Required)
Stay in the Loop with WOTA
Would you like reminders and updates about your rides? Opt in below and you’ll receive a text or phone call:
  • * The night before your appointment
  • * About 15 minutes before your ride arrives
  • * Any time WOTA is closed

You may opt out at any time, and consent is not required to use the service. Message and data rates may apply.

Please select only one method of contact

*PLEASE NOTE: Based on the status of our riders, if you are a regular rider and you are scheduled but you do not call to cancel your ride, you do not answer your phone and nor do you come out when the driver arrives, we reserve the right to call for a non-emergent welfare check to ensure your safety and well-being.
Sometimes WOTA takes pictures of it’s clientele for promotional and/or historical documentation purposes. By signing this form you give consent for WOTA to use your picture in those promotions, unless you check the “no” box.
Consent to Use Electronic Signature(Required)
I am unable to use finger/mouse or file upload to sign and will only type my name in "Signature Typed" box below.
Ignore this input if you plan to sign by finger/mouse or file upload.
Clear Signature
I choose to upload a digital version of my signature
Accepted file types: png, jpg, pdf, doc, docx, Max. file size: 512 MB.
Date of Signature(Required)
I have read and understand the rules and regulations regarding the use of transportation through the West Oakland Transportation Authority (WOTA). By signing this form, I acknowledge I will follow the rules and regulations of scheduling and riding the organization’s vehicles.