Village of Arlington Heights

Taxi Subsidy- Arlington Rides

This program provides discounted taxi rides for low-income seniors and persons with disabilities. Qualifying individuals receive a $5 discount per ride with a maximum of 20 rides per month.

Residents that qualify must be at or below 250% of the poverty guidelines.

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

If you have any questions, please contact Erin Mercado at 847-368-5793 or emercado@vah.com

Phone Number

Date of Birth

Age

Gender

Members of Household

Household Member #2

Relationship to Applicant

Date of Birth

Gender

Is this family member an additional applicant?

Yes

Household Member #3

Relationship to Applicant

Date of Birth

Gender

Is this family member an additional applicant?

Yes

Household Member #4

Relationship to Applicant

Date of Birth

Gender

Is this family member an additional applicant?

Yes

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.

PHYSICIAN CERTIFICATION OF DISABILITY (if under 65) OR CURRENT SSDI/SSI AWARD LETTER
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.
LEASE OR MORTGAGE STATEMENT
UTILITY BILL: (Gas or electric bill)
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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I hereby apply for participation in Arlington Rides offered by the Village of Arlington Heights. All information on this application is accurate. I authorize the Disability Services Coordinator to authenticate this information.