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Filling out this form is simple and straightforward. Start by entering all the necessary personal and contact information. Ensure to provide accurate emergency contact details and destination information.

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How to fill out the Catholic Charities Fort Worth Transportation Services Form?

  1. 1

    Enter your full name and contact information.

  2. 2

    Provide your home address and any additional information about your apartment.

  3. 3

    Select your ethnicity, race, and gender.

  4. 4

    Fill in the details of your trip purpose and destination.

  5. 5

    Sign the form and submit it for verification.

Who needs the Catholic Charities Fort Worth Transportation Services Form?

  1. 1

    Clients of Catholic Charities Fort Worth who need transportation services.

  2. 2

    Individuals requiring transit to school or employment within the HEB area.

  3. 3

    People who need to provide emergency contact information for their transit needs.

  4. 4

    Clients who need to update their personal details or contact information.

  5. 5

    Individuals applying for transportation services and needing to certify their information.

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What are the instructions for submitting this form?

Submit the completed form via email to transportation@ccfw.org, or fax it to (817) 123-4567. You can also submit the form online using the provided submission form link on the Catholic Charities Fort Worth website. Alternatively, you may mail the completed form to Catholic Charities Fort Worth, Transportation Services, 249 W. Thornhill Drive, Fort Worth, TX 76115. Ensure all required fields are completed, and the form is signed before submission. It is recommended to keep a copy of the submitted form for your records.

What are the important dates for this form in 2024 and 2025?

Make sure to submit your form before the scheduled transportation date. For 2024 and 2025, ensure all forms are submitted at least two weeks prior to the transportation service date to avoid any delays.

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What is the purpose of this form?

The purpose of this form is to collect necessary information from clients of Catholic Charities Fort Worth who need transportation services. It gathers personal details, contact information, emergency contacts, and destination information to ensure that transportation services are provided effectively. Submitting this form accurately and on time helps streamline the process and ensures clients receive the required support.

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Tell me about this form and its components and fields line-by-line.

This form contains several fields that require detailed information from the client to ensure proper provision of transportation services.
fields
  • 1. Client Name: The full name of the client requesting transportation services.
  • 2. Home Address and Apt/Unit #: The full residential address of the client including apartment or unit number if applicable.
  • 3. Apartment Complex Name: The name of the apartment complex where the client resides.
  • 4. Primary Phone: The primary contact phone number of the client.
  • 5. Date of Birth: The client's date of birth.
  • 6. City and Zip Code: The city and zip code of the client's residence.
  • 7. Secondary Phone: An alternate contact phone number for the client.
  • 8. Emergency Contact Name and Number: Name and phone number of the person to contact in case of an emergency.
  • 9. Ethnicity and Race: Ethnicity and race options to describe the client's background.
  • 10. Gender: The gender of the client.
  • 11. Number of People in Household: The total number of people in the client's household.
  • 12. Total Annual Household Income: The total annual income of the client's household.
  • 13. Destination Details: Details about the destination, including purpose, address, and city.
  • 14. Client Signature and Date: Client's signature and the date of signing to certify the information provided.
  • 15. Staff Signature and Date: Staff's signature and date verifying the completion of the form.
  • 16. Written Notice of Beneficiary Rights Receipt: Indicates whether the client has received the written notice of beneficiary rights.

What happens if I fail to submit this form?

Failing to submit this form may result in the inability to access transportation services through Catholic Charities Fort Worth.

  • Service Denial: Clients may be denied transportation services if the form is not submitted.
  • Delayed Processing: Delays in processing requests for transportation services due to incomplete information.
  • Inaccurate Records: Records may not be updated correctly without a submitted form.

How do I know when to use this form?

Use this form whenever you need to request transportation services from Catholic Charities Fort Worth.
fields
  • 1. New Service Requests: Submit this form when applying for new transportation services.
  • 2. Updating Information: Use this form to update personal and contact information.
  • 3. Emergency Contact Changes: Inform changes to emergency contact details using this form.
  • 4. Trip Purpose Changes: Use this form to update the purpose and details of your trip.
  • 5. Annual Verification: Resubmit the form annually to verify and update information on record.

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