Bus Pass Application Form
We hope that your transportation needs can be met by an AAATA bus pass. Please complete the following to give us a little more information about yourself.

Washtenaw FAN is able to assist by providing one bus pass per person, on a one-time basis. If you are accepted, you will receive details on where to pick up your buss pass at our East Ann Arbor or West Ann Arbor locations.
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First Name *
Last Name *
Email Address *
Phone Number *
This should be a working phone number where we can reach you to coordinate the bus pass.
Street Address *
City *
Zip Code *
Age
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Race & Ethnicity
Gender
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Have you previously applied for Washtenaw FAN's Bus Pass program? *
If you are in recovery or live a sober lifestyle, how long have you been sober? *
When was the last time you needed to receive drug- or alcohol-related medical assistance? *
Do you currently participate in a program of recovery? *
If yes, how many hours per week are you engaging in activities or with individuals in the recovery community?
Are you currently in a residential treatment facility? *
If yes, what is the name of the facility?
We like to respond quickly to your application and this will help us get in touch.
Which of these recovery activities do you currently participate in?
Please rate your ability to get transportation to recovery services:
Very difficult
Very easy
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How often did you ride the bus in the past 30 days? *
In the past (30) days, how often have you felt isolated from others or completely alone? *
How did you hear about the Bus Pass program? *
Required
List the email addresses of anyone that you want to know about your acceptance into the Bus Pass program.  E.g. therapist, recovery coach, house manager, etc. *
Were you aware of these other beneficial services offered by Washtenaw FAN? See https://www.familiesagainstnarcotics.org/washtenaw for information about participating in these services.
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