Community Access Pass Program Application

As a vital component in the Spokane community’s social fabric, economic infrastructure, and quality of life, Spokane Transit Authority (STA) is proud to partner with nonprofit human services agencies (HSAs) to increase access to transit for vulnerable populations.

Approved nonprofit entities may purchase one ride and day passes in bulk for half price through the Community Access Pass Program. Passes purchased through this Program may not be re-sold. They must be distributed to clients, patients, or customers of the approved HSA free of charge. Further, approved HSAs may not give or sell passes from this Program to their employees.

To qualify for this Program, an agency must be a 501(c)3 Human Service Agency and must be listed on the IRS Publication 78 Tax Exempt Search or the Exempt Organizations/Business Master File (EO/BMF) found on the IRS website and must complete and submit this Application form for approval.

All pass sales will be final, and no exchanges or refunds will be made. It is advised to purchase no more than one year's worth of passes at a time.

Spokane Transit assures nondiscrimination in accordance with Title VI of the Civil Rights Act of 1964 and the Americans with Disabilities Act.

For more information, visit www.spokanetransit.com/projects/title-vi-non-discrimination-policy-and-program/. All phone numbers are accessible for people who are deaf or hard of hearing through Relay 711. Upon request, alternative formats of this document will be produced for people who are disabled. Call (509) 325-6094 or email ombudsman@spokanetransit.com.

Agency/Organization Name*

Years in Existence*

Contact Name*

First NameLast Name

Phone Number*

Email*

Confirmation Email

Is the contact above who you would like to be the administrator on your STA account?*

YesNo

Administrator Name

First NameLast Name

Administrator Phone Number

Administrator Email

Confirmation Email

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please list other departments or Programs that might purchase passes under this application.

Example: Anna Ogden Hall is a program that would fall under the Union Gospel Mission umbrella

501(c)(3) Status

To be approved, your organization must be listed on the IRS Tax Exempt Organization website. You can verify this by visiting: Tax Exempt Organization Search Tool or by checking the Exempt Organizations Business Master File Extract found here: EO BMF

Are you a 501(c)3 entity?*

YesNo

Agency/Organization EIN*

The Community Access Pass program is for 501(c)3 nonprofits only.

Understanding the goal of this pilot program is to increase access to public transit, how does your organization anticipate utilizing this program? (select one)*

Purchase more passes within the next 12-monthsPurchase the same number of passes in tPurchase fewer passes during the 12-month Pilot Program than my organization did in 2019.

To whom do you intend to distribute passes through this Program? Check all that apply:*

Patients in programs treating illness or substance abuse.Clients receiving children and family services, including children living in foster care.Clients of programs that provide food, shelter, or employment opportunities.Clients of programs serving victims of domestic violence.Clients of programs serving refugees and other populations with limited English proficiency.Individuals with disabilities.Individuals living at/below 200% of the Federal Poverty Level.

If your agency will be using this program to serve individuals with disabilities and/or individuals living at/below 200% of the Federal Poverty Level, describe your agency’s process to verify clients meet those qualifications.

Describe the population(s) you serve and their unique transportation needs.*

Describe the distribution process for the subsidized passes.*

Approximately how many 2-Hour Passes do you anticipating purchasing in the next 12 months?

Approximately how many Day Passes do you anticipating purchasing in the next 12 months?

Approximately how many One-Way Paratransit Passes do you anticipating purchasing in the next 12 months?

I understand one ride and day passes are being discounted to allow my organization to purchase more passes than previously purchased, without spending more money, in order to increase access to transportation to vulnerable populations.*

YesNo

Community Access Pass Program Application

Section 1: General Information

Section 2: Description of Population(s) Served

Section 3: Certification