Transportation Assistance Program Application

Membership and participation in NLTAP is conditioned upon adherence to the Code of Conduct set forth below, as well as any NLTAP Rules established by the City of North Liberty, which are available online. By participating in NLTAP, you agree to abide by this Code of Conduct and the NLTAP Rules.

The purpose of this Code of Conduct is to ensure the safety and comfort of North Liberty Transportation Assistance Program (NLTAP) cardholders, partners, providers, and of the general public. Violent, illegal, disrespectful behavior, demeaning language, yelling, or other seriously disruptive conduct is not permitted in connection with NLTAP membership or ridership. This provision extends to NLTAP cardholders, cardholder dependents, additional riders such as personal care attendants, as well as service animals and pets. NLTAP may deny, suspend, or revoke membership, and Yellow Transport may refuse service, to any persons who engage in such conduct.

Notwithstanding the above, neither On-Demand Transit Services nor NLTAP membership will be refused to an individual with disabilities solely because the individual’s disability results in an appearance or involuntary behavior (sounds or actions) that may offend, annoy, or inconvenience NLTAP staff, providers, or partners.

When a person has engaged in behavior that violates this Code of Conduct, Yellow Transport will inform the NLTAP Coordinator at the City of North Liberty of the circumstances and events surrounding that behavior. City staff will evaluate on a case-by-case basis what corrective action, if any, is warranted. Such action may range from warnings to suspension of NLTAP program privileges, to permanent revocation of the offending person’s membership in NLTAP.

The undersigned applicant (the “Applicant”) authorizes the City of North Liberty, Iowa, to contact any service or benefit providers indicated in this application for the purpose of verifying the documentation provided, and to verify Applicant’s eligibility for the North Liberty Transportation Assistance Program (“NLTAP”).

Applicant agrees that membership in NLTAP, if approved, is effective only for the period that the applicant qualifies to receive services, and that membership in NLTAP must be renewed on an annual basis or upon termination date of a temporary pass, whichever happens first.

Applicant understands and agrees that the City of North Liberty may terminate the Transportation Assistance Program for any reason. In the event the Transportation Assistance Program is terminated, the City of North Liberty will mail a written notice to the address on this application at least 10 days prior to the termination date. Applicant hereby specifically waives any claim or cause for damages resulting from the cancellation or discontinuation of the Transportation Assistance Program.

By submitting this application, the Applicant attests that all statements on this application are true and correct, and agrees that intentionally false statements made on this application will be grounds for the City of North Liberty to deny the application or to cancel Applicant’s membership in NLTAP.

Applicant agrees that they have reviewed the NLTAP Program Information, Cardholder User Guide, and Code of Conduct documents, and agrees to abide by the terms contained therein, including all program rules and restrictions as may be modified from time to time.

Applicant acknowledges that NLTAP passes are for the exclusive use of NLTAP members, and may not be shared. Applicant agrees that, if applicant’s pass is lost or stolen, to the applicant will report that loss immediately. Applicant understands that violation of any of these terms will result in the immediate cancellation of Applicant’s membership in NLTAP.

If this application is signed by a preparer (“Preparer”) on behalf of the Applicant, Preparer affirms that Applicant understands and agrees to the terms of membership described in this application, and that the application was prepared at Applicant’s direction.