Aging Services Transportation Program Application

The Aging Services Transportation Program is…


The Aging Services Transportation Program provides transportation services to non-emergent medical appointments, pharmacies, grocery stores, food banks, and other essential errands. Services are provided by volunteers (using their own vehicles) and a staff driver.


To be eligible for the Transportation Program…

  • Individuals must be age 60+
  • Be able to walk independently and get in/out of vehicle with little or no assistance.
  • Participants who use a cane or walker are eligible if they meet the above requirements.
  • Wheelchairs cannot be accommodated at this time.

Interested individuals must apply to be considered for the program. Upon receipt and assessment of a completed application, the Transportation Program Coordinator will notify the individual of their acceptance status.


Aging Services and its programs will consider this application without regard to race, color, creed, religion, national origin, gender, sexual orientation, disability, age, marital status, public assistance status, genetic or family medical history, or any other protected classification under local, state or federal law.












For example: medical appointments, groceries, etc.

For example: oxygen, walker, etc.








Please indicate you agree to the following statements by selecting 'I agree' and signing your name. 





Authorization for Release of Information for Program Volunteers

I hereby authorize Aging Services and the Transportation Program to release to and exchange relevant information with the following individuals and agencies:

  • Transportation Program Volunteers
  • Emergency Family Contact listed below
  • Additional individuals listen below, if any (friends, family members, caregivers, physicians, etc.)

This information will be used to schedule appointments with drivers, coordinate transportation services, communicate with and report relevant information (as needed) to the listed contact(s), report relevant information to partner agencies, procure grants, and support funding.


Prohibition on Re-disclosure

This form does not authorize re-disclosure of medical information beyond the limits of this consent. Where information has been disclosed from records protected by federal law for alcohol/drug abuse records or by state law for mental health records, federal requirements (41 D.F.R. Part 2) and state requirements (Iowa Code ch. 228) prohibit further disclosure without the specific written consent of the patient, or as otherwise permitted by such law and/or regulation. A general authorization for the release of medical or other information is not sufficient for these purposes. Civil and/or criminal penalties may attach for unauthorized disclosure of alcohol/drug abuse or mental health information.









Enter name, phone number and relationship of additional individuals you are authorizing

Transportation Program Service Agreement

Aging Services Transportation Program Overview


The Aging Services Transportation Program provides transportation services to non-emergent medical appointments, pharmacies, grocery stores, food banks, and other essential errands. Services are provided by volunteers (using their own vehicles) and a staff driver.


Aging Services Transportation Program Eligibility


The Aging Services Transportation Program is designed to meet the needs of individuals at least 60 years old. All participants must be able to walk independently and get in and out of a vehicle with little or no assistance. Participants who use a cane or walker are eligible if they meet the above requirements. Wheelchairs cannot be accommodated at this time.


Interested individuals must apply to be considered for the program. Upon receipt and assessment of a completed application, the Transportation Program Coordinator will notify the individual of their acceptance status.


Aging Services Transportation Program Cost


There is currently no charge to participants for the Aging Services Transportation Program’s services. Participants should not pay, or engage in any other financial transactions with, program drivers. Those wishing to make financial contributions are welcome to mail tax-deductible donations to:

Aging Services Transportation Program

1725 O Ave NW

Cedar Rapids, IA 52405


Aging Services Transportation Program Scheduling


To request a ride, participants must call the Aging Services office at (319) 398-3647, option 4, and provide the date, time, and location of the appointment or errand. The Transportation Program Coordinator will arrange for a driver and call the participant to confirm the services. The driver will call the participant no more than 24 hours before the scheduled service to confirm the drive’s details. Participants must be ready for the driver at the scheduled pick-up time.


Please note:

  • Requests will be filled as driver availability allows, with priority being given to medical appointments and those participants who may not have other transportation resources available.
  • Making a request for transportation services is not a guarantee that a driver will be available.
  • Requests for transportation services to standing appointments cannot be accommodated at this time.
  • Participants must not request, schedule, or cancel services directly with drivers.
  • Stopping at restaurants or other ineligible locations, even if they are on the way to or from an approved location, is NOT permissible.

IMPORTANT NOTE

The Aging Services Transportation Program depends on volunteers and funding from various sources. Participants repeatedly violating policy, asking a driver to disregard policy, or choosing to mistreat a volunteer or staff member in any way will be immediately and permanently removed from the Aging Services Transportation Program. This is not an exhaustive list of all applicable Transportation Program policies. Aging Services reserves the right to change or discontinue the Transportation Program at any time based on participant needs, volunteer needs, organizational needs, safety concerns, changes in funding, or other currently known or unknown circumstances.

Aging Services Transportation Program Policies
  • Transportation services are available Monday through Friday from 8:30 am to 4:00 pm. This allows the drivers to have all participants returned home before the end of the Aging Services business day. Please plan accordingly when scheduling appointments and requesting services.
  • Services must be requested a minimum of seven (7) days prior to the appointment or errand. This provides the Transportation Program Coordinator sufficient time to arrange a driver. (Example: a Tuesday appointment must be requested no later than the previous Tuesday.)
  • All stops must be scheduled and approved in advance by the Transportation Program Coordinator. Any additional stops must be requested when making the initial service request. Additional stops cannot be accommodated on the day of the drive.
  • Participants utilizing walkers must remove all personal belongings, including walker bags, from the walker. This ensures the safety of the driver when loading and unloading the walker from the vehicle.
  • Services should be canceled at least 24 hours in advance to ensure that the Transportation Program Coordinator has time to notify the driver. Repeated short-notice cancellations or other recurring communication issues may result in being discharged from the program.
  • Drivers may stay in their vehicles, wait in the waiting room, or leave the premises while a participant’s appointment or errand is in progress. Participants should discuss the plan with their driver during the confirmation call.
  • Drivers may, at their own discretion, provide limited assistance in stores and/or help participants carry groceries to their home. Drivers will not, under any circumstances, enter a participant’s home.
  • If a caregiver or loved one wants to accompany a participant to an appointment or errand, they must also have an approved application for the Aging Services Transportation Program on file. Only individuals with approved applications may be in Transportation Program vehicles.
  • In consideration of our drivers’ time, we are unable to provide transportation services to superstores such as Walmart, Target, and Sam’s Club.
  • Requests for transportation services to medical appointments that require frequent and regular repeat visits, such as physical therapy, dialysis, and infusions, cannot be accommodated at this time.
  • For the safety of our participants and drivers, the Aging Services Transportation Program is unable to provide drives home from any procedure requiring anesthesia, or for any participant who needs a second party to sign them out from a location.


Consumer Intake Questions

The transportation services you are receiving is paid for entirely or partially by funds from the federal Older Americans Act and the State of Iowa. Your responses on this form are confidential. This information is used to comply with reporting requirements and research the needs of older Iowans. Thank you.


























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