METROLift Eligibility Appeal

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Contact Information

First Name*

Last Name*

METROLift ID*

Home Address*

Apartment Number

City*

State*

Zip Code*

Phone Number*

Email*

Appeal Questions

Select the reason for appealing your eligibility decision:

My METROLift service was denied and I am appealing for ADA paratransit eligibility.
I was granted temporary eligibility and I am appealing for longer ADA paratransit eligibility.

Select how you would like to present your case:

In-person hearing
Telephone hearing
Proceed without my presence

Acknowledgment and Agreement

I understand that my appeal, (including any additional information), must be received within 60 days of notification of eligibility determination.

I understand that the decision of the Appeals Hearing Officer is final.

I understand that I have the right to use the service if the Appeals Hearing Officer has not made a decision within 30 days of the completion of the appeals process.

Agreement

I Agree

Questions or Comments?

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METROLift Eligibility Appeal

Contact Information

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