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Village of Arlington Heights

communications@vah.com

33 S. Arlington Heights Road , Arlington Heights , IL, 60005, US

847-368-5000

Village of Arlington Heights

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Taxi Subsidy- Arlington Rides

If you have any questions, please contact the Health & Human Services Department at 847-368-5760 or HealthMail@vah.com

Full Name

Full Address

Date of Birth

Date Picker

Members of Household

Household Member #2

Full Name

Date of Birth

Date Picker

Is this family member an additional applicant?

Household Member #3

Full Name

Date of Birth

Date Picker

Is this family member an additional applicant?

Household Member #4

Full Name

Date of Birth

Date Picker

Is this family member an additional applicant?

Required Attachments

Attach list of other household members to form

Low-income seniors (age 65 and up) and persons with disabilities (age 18 and up) - $5 per ride discount.

MUST BE AT OR BELOW 250% OF THE POVERTY GUIDELINES

1 person

2 people

3 people

4 people

5 people

6 people

7 people

8 people

$30,350

$41,150

$51,950

$64,450

$73,550

$84,350

$95,150

$105,950

Please attach the following below.

  1. PHYSICIAN CERTIFICATION OF DISABILITY (if under 65) OR CURRENT SSDI/SSI AWARD LETTER
  2. IF APPLICABLE, ATTACH LIST OF ALL OTHER HOUSE MEMBERS. IDENTIFICATION FOR EACH MEMBER OF HOUSEHOLD: Driver’s license, State ID, with For children we will accept school forms with their name, all require Arlington Heights addresses.
  3. LEASE OR MORTGAGE STATEMENT
  4. UTILITY BILL: (Gas or electric bill)
  5. TOTAL HOUSEHOLD INCOME: All that apply: 3 months pay stubs with length of pay period indicated OR current Disability, SSDI/SSI/Social Security Retirement, or Unemployment award letter OR W2 form OR Tax return (if it is the same as current amount).

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