Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Request to Join Voucher Program Waitlist

  1. Douglas County residents may submit this form to be added to the Transportation Voucher Program Waitlist.

    Make sure to provide accurate contact information so that you may be notified to enroll in the program.

    Please submit only one form per person!

  2. Contact Information
  3. Optional

  4. About You
  5. Select your eligibility category:*

    To participate in the voucher program, you must fall under one of the categories below.

  6. Marital Status
  7. Household Size
  8. Source of Income

    Check all that apply.

  9. You are not required to share any private health information. Please briefly describe your disability and any mobility limitations you have.

  10. Frequent Trips and Destinations

    Indicate the type of trips or destinations for which you require transportation assistance. Please check all that apply.

  11. Leave This Blank:

  12. This field is not part of the form submission.