Basic Eligibility Form

RTA Discount Bus Pass and RTA Senior VIP Gold Pass

This form is ONLY for those who are:

VIP Gold Pass

  1. Age 80 or over

Discount Photo ID Card

  1. Age 65-79 years (Senior Discount pass), or
  2. A disabled U.S. veteran, or
  3. Have a valid DMV placard or registration for a permanent disabled license plate or parking placard, or
  4. Medicare card, Social Security disability letter, proof of disability from the CA Dept. of
    Rehabilitation, ADA card, Braille Institute card, or a disability card issued by another transit agency.

Read the directions carefully before completing this form.

Fraud or a misstatement of fact will disqualify the applicant from receiving the benefits of the RTA Discount Pass Program.


File in Person

Riders can come into our offices where they will complete the Basic Eligibility form, verify eligibility, take a photo and we will issue the RTA Discount Eligibility Card. Please call ahead to ensure that staff will be available to help you. (805) 541-2228 x 4833

Download PDF – EnglishDownload PDF – Spanish

    SECTION 1. APPLICANT INFORMATION


    SECTION 2. CERTIFICATION OF ELIGIBILITY

    Please mark your eligibility category below. Check ONLY ONE category.
    PLEASE INCLUDE COPIES OF: (1) PROOF OF ONE OF THE FOLLOWING, and (2) VALID PHOTO ID.

    Check only ONE category

    Required identification/documentation

    IDENTIFICATION CARD
    Must be at least 80 within one (1) month.

    IDENTIFICATION CARD
    Must be at least 65 within one (1) month.

    Applicant must provide a copy of a documented VA claim number to transit staff. Accepted documentation includes a card or original letter on VA letterhead.

    I authorize the RTA Discount Pass Program to confirm my name and disability rating through the Veterans Administration.

    Applicant must provide a copy of a valid DMV placard or valid registration for a permanent disabled license plate or parking placard to transit staff.

    I authorize the RTA Discount Pass Program to confirm the placard ownership and expiration date through DMV.

    Applicant must provide a copy of a Medicare card to transit staff.

    Applicant must provide a copy of a Social Security Administration SSI disability letter to transit staff.

    Applicant must provide proof of disability from the California Department of Rehabilitation.

    Upload supporting documentation
    (1) PROOF OF ONE OF THE ABOVE, and (2) VALID PHOTO ID

    Provide up to three PDF, JPG or PNG files. Maximum 5 MB per file.




    I attest that the information on this application is true and correct.

    Signature of Applicant:



    Photo ID applications that are turned in online will receive their cards through the US mail. Please allow 3 weeks for processing and mailing.