FAIR TRANSIT PROGRAM APPLICATION FORM

The purpose of this application form is to assess the eligibility of your household to receive discounts
on Innisfil Transit fares. Only Innisfil residents in households below the "Low Income Cut-Off"
established by Statistics Canada or currently receiving Ontario Works or Ontario Disability Support
Program payments will be eligible.

Before filling out this form, please ensure you have an electronic copy of the following documents to upload with your application:

Proof of residence - License, tax or Utility Bill
Statement of Ontario Works benefits (if applicable)
Statement of Ontario Disability Support benefits (if applicable)
last year's Notice of Assessment for yourself, spouse and dependants (as applicable)
most recent Child Tax Benefit (if applicable)
HST Notice (if applicable)

Fee Assistance in Recreation Program

If eligible for the Fair Transit program, you will also be automatically approved for the Town's Fee
Assistance in Recreation program where you may receive up to 25% off of a program registration fee
to a maximum of $200 per year/ per participant. This assistance will only apply to Town of Innisfil
programs and shinny/ skating passes.

Would you also like to participate in the Fee Assistance in Recreation program

SECTION 1: APPLICANT INFORMATION

Who is applying?

Yourself only

Yourself and your spouse/partner/other dependents

Full Name
	last name	first name	middle name

Gender	Male	Female	Other
Phone Number on Uber Account
Email address
Date of Birth

Address
	Street Address		Appt No

	City	Province	Postal Code

Notice of Assessment

Please Upload a copy of last year's Notice of Assessment for yourself
as it relates to the General Income Tax Form (3 page document you receive
from the Canada Revenue Agency after filing your personal income tax return).
Call 1-800-959-8281 if you have lost your copy and need a replacement

Proof of Residence

Please Upload one of the following:

Photocopy of license
Photocopy of recent utility bill
Municipal tax bill
Other official document containing your name and address

Marital Status

Married/ Common Law

Single

Separated/ Divorced

Employer
	Name	Address

If Applicable, upload your most recent monthly benefits statement Ontario Works benefits

If Applicable, upload your most recent monthly benefits statement Ontario Disability Support Program benefits

SECTION 2: SPOUSE/ PARTNER INFORMATION

Full Name
	last name	first name	middle name

Gender	Male	Female	Other
Phone Number on Uber Account
Date of Birth

Address
	Street Address		Appt No

	City	Province	Postal Code

Employer
	Name	Address

Notice of Assessment

Please Upload a copy of last year's Notice of Assessment for your spouse/partner
as it relates to the General Income Tax Form (3 page document you receive
from the Canada Revenue Agency after filing your personal income tax return).
Call 1-800-959-8281 if you have lost your copy and need a replacement

SECTION 3: OTHERS IN HOUSEHOLD

(*must be living at same address, include phone number for those 13 years or older with an Uber account)

First Name	Last Name	Age	Ph. Number/Uber Account

If Applicable, upload a copy of your most recent Child Tax Benefit or HST Notice (pages 1 and 2) for all dependants.

SECTION 4: INCOME/ELIGIBILITY

To be eligible, your income (after tax) must be less than the amount shown in the Statistics Canada Low-Income Cut-Off
table. Family size includes you, your spouse or partner and dependents under 18 living in your home. Choose your family size:

Family size 1 with Income after tax below $17,536

Family size 2 with Income after tax below $21,344

Family size 3 with Income after tax below $26,577

Family size 4 with Income after tax below $33,157

Family size 5 with Income after tax below $37,757

Family size 6 with Income after tax below $41,874

Family size 7+ with Income after tax below $45,989

SECTION 5: APPLICATION CONFIRMATION

By checking this box, the Applicant declares that all information provided is true to the best of their knowledge.
The Applicant further acknowledges that providing any false information on this form may result in the request being denied.

If you have any questions regarding administrative aspects of this form, please contact Customer Service at inquiry@innisfil.ca or 705-436-3710

Upon receiving this application, the Town will make best efforts to provide a written response to the Applicant within 5 business days. In assessing the application, the Town may contact the Applicant for further information.

Personal information collected on this form is pursuant to the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, Chapter M.56, as amended, and will be used to process your application. Information may also be used for administration and to ensure compliance with the Fair Transit Program or Fee Assistance in Recreation Program. Information may be disclosed to Uber for the purpose of implementing the program, if approved. Questions about this collection should be directed to: Clerk's Office, Town of Innisfil, 2101 Innisfil Beach Road, Innisfil ON, L9S 1A1, 705-436-3710 or email clerksoffice@innisfil.ca