Committee for Transit Accessibility
(Human Service Agency)
Nomination Form

The Santa Clara Valley Transportation Authority (VTA) formed a Committee for Transit Accessibility (CTA) to facilitate communications and receive input from interested individuals with disabilities and from human service agencies.  The Committee advises the Transportation Authority Board of Directors on matters pertaining to accessibility of the bus and rail system and paratransit services.  The Committee is composed of 21 members, who are appointed by the Chairperson of the Board of Directors.  Regular meetings of the Committee are held on a monthly basis.  Committee members should be prepared to devote approximately eight hours per month to Committee activities.  The Committee will not have independent duties or authority to take action that binds the Valley Transportation Authority Board of Directors.  

Please complete this nomination form and attach a current brochure or handbook.

Name of Organization:

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Mailing Address:

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Phone Number:

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Please list and briefly describe your clientele and the types of persons with disabilities currently served by your agency.

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Please provide a listing of the cities in Santa Clara County in which your services are available, and include the number of persons with disabilities served on an annual basis.

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Please briefly describe your Agency's interest related to public transit for persons with disabilities.

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Please list your qualifications, citing your agency's experience related to public transit for persons with disabilities. 

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Please indicate the name and title of the employee from your agency that you will designate to participate and meet membership obligations.

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Does your agency or designee have any obligations that might affect attendance at meetings scheduled for the second week of the month?  If yes, please explain:  

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This space is provided for any additional information you may have about your agency. 

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Our agency will commit sufficient time to this responsibility and our representative will attend the required meetings if it is appointed. 

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Date						Signature

We appreciate your interest in serving VTA and will keep your application on file for one year from the date of receipt.  

If you have any questions about this application or the Committee for Transit Accessibility, please contact VTA's Office of the Board Secretary at (408) 321-5680.  Please mail the completed application to the VTA, Office of the Board Secretary, 3331 North First Street, San Jose, California 95134-1927.