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Contact Commuter Services today by Email, or call 1.866.579.RIDE

 

 

 

 

 


Application Form

Rideshare Registration for: Emergency Ride Home Program


I do not wish to be matched, but am eligible for the Emergency Ride Home Program; I use one of the commute options listed below (other than driving alone) at least two (2) days per week.

** Please note that if you have previously signed up to receive carpool or vanpool matches you are automatically enrolled for the ERH program

Fields marked (*) are required

Applicant Information:

* Last Name: * First Name: Middle Initial:

* Home Street Address: Apt #: Bldg #:

* City: * State: * Zip Code:

* Home Phone: * Alternate Phone: Sex (M/F):

* Email Address:

Nearest intersection to your home: and


Company Information:

* Company Name:

* Company Street Address: Suite #:

* City: * State: * Zip Code:

Department: Mailstop:

Main Phone: Direct Phone or Extension:

Nearest intersection to your work place: and


Work Hours:

* Start Time: AM PM

* End Time: AM PM


Days that you work: (check all that apply)

Mon Tues Wed Thurs Fri Sat Sun

Can you arrive and/or leave work within 15, 30 or 45 minutes of your scheduled time?
Yes No

If you answered YES to the above question, check one of the following:
15 30 45


Commuting Information:

Mark the NUMBER of days per week you use each of the following methods of transportation to get to work:

Drive Alone

Carpool/with how many other people?

Vanpool/with how many other people?

Bus

Train

Walk

Bike

Telework

How long have you used your current method of commuting? Years Months

Additional Information:

How did you learn about Commuter Services?



Commuter Services is a program of the non-profit Susquehanna Regional Transportation Partnership, whose board includes the Harrisburg Regional Chamber; the Gettysburg Adams, Lebanon Valley and York County Chambers of Commerce; Lancaster Chamber of Commerce & Industry; Adams County Transit Authority (ACTA); County of Lebanon Transit Authority (COLT); Red Rose Transit Authority (Lancaster); York County Transportation Authority (rabbittransit); Capital Area Transit (CAT, Cumberland-Dauphin-Harrisburg); the Lancaster, Lebanon and York metropolitan planning organizations (MPOs); Harrisburg MPO (Cumberland, Dauphin and Perry counties) and Adams Rural Planning Organization (RPO). One board seat is also set aside for a corporate executive. Funding is provided by the Federal Highway Administration and PennDOT.

Commuter Services • 2951 Whiteford Rd. Suite 201 • York, PA 17402