(Logo for Santa Clara Valley Transportation Authority) 


Committee for Transit Accessibility
(Individuals with Disabilities)
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 resume, if available.

Name:


Home Address:



Home Phone Number:


Work Phone Number:


Please list and briefly describe your involvement with any community or professional 
organizations that are relevant to your candidacy for the CTA:
(type answer here) 




Please indicate your primary disability:
(type answer here)



 

Please briefly describe your interest in serving on the Committee for Transit 
Accessibility, citing any experience related to individuals with disabilities:
(type answer here) 




Please list your qualifications, including your experience using regular bus and rail 
services or paratransit service:
(type answer here) 




Do you have any obligations that might affect your attendance at meetings scheduled for 
the second week of the month?  If yes, please explain:
(type answer here) 




This space is provided for any additional information you may have about yourself:
(type answer here) 





I have sufficient time to devote to this responsibility and will attend the required 
meetings if I am appointed.
					
________________________________________
Signature

We appreciate your interest in serving VTA and will keep your application on file for 1 
year from the date of receipt.  

If you have any questions about this application or the Committee for Transit 
Accessibility, please contact the Office of the Board Secretary, at (408) 321-5680.  Please mail the completed application to the Valley Transportation 
Authority, Office of the Board Secretary, 3331 North First Street, San Jose, California 
95134-1906.