Common Courtesy is a non-profit with a mission to partner to provide safe, affordable or even no-cost transportation to those unable to operate a vehicle safely.

Money is raised by:

Religious Organizations

Senior Living Communities Healthcare Providers Retailers Friends Senior Organizations

*Each organization maintains their own “bucket” of funds to sponsor rides.

This money is used to sponsor the costs of providing rides for those who can no longer drive and want to

maintain their independence.

We partner with Uber, a technology based transportation company that uses smart phones to connect drivers and riders. And now with Caliber for ADA wheelchair accessible. We connect riders that cannot drive or do not have transportation, with drivers from Uber.

Funding from

sponsors

Organizations

Family

Friends

Communities

Businesses

Civic

Associations

Neighborhood

Associations

Neighborhood

Grocery / Pharmacy

General Funding Religious

Organizations

Corporate

Donors

Grants

Bucket One $$$ Bucket

Five $$$

Bucket Two $$$

Bucket Three $$$

Bucket Four $$$

A rider may need transportation to the grocery store, doctor appointment, mall, social activities, etc.

Obtaining a ride begins by registering with Common Courtesy

There are two ways to make arrangements for a ride:

1. The rider can use the Uber App on their smart phone

2. The rider can call the dispatch phone number Common Courtesy requests 24 hours advanced notice to dispatch rides

// uberX: the low-cost Uber in Atlanta (and the choice for Common Courtesy)

Rider Registration Information

In order to become a funded Rider (that is your rides are free), you will need to go through a few steps! Because we are a non-profit we must determine that you are someone who “cannot or should not” be driving a personal vehicle. In most cases this is not difficult yet we must make certain that those who can otherwise afford or secure transportation are not using much needed funding dollars!

The system: How it works

a. Rider Registration

First Step: Potential rider* will complete a Rider application / Registration Form, either online in pdf format or as a hand written format to be sent to CCI.

CCI staff (individually or as a team) will review the application to meet the established parameters under the funding source’s desired set of criteria.

a. If Rider is approved, a code/tag will be assigned and the basic rider information for Uber or

other service will be input into system. Applicant Rider will be notified and requested to

attend a Rider Travel Training (Rules of the Road) in a group setting. CCI Volunteer will

lead the training session and each graduate will be activated.

b. Rider may activate or initiate a ride 24 hours after the training using a smartphone device

that they own.*

c. All rides for a selected subset of donations will be reported weekly to the donor source (if

desired).

Riders must meet criteria of Funding Source such as low-income, older-adult, physically

impaired, or one suffering from a critical disease and requiring routine medical treatments.

*Using a smartphone devices class can be obtained for $15.00

CommonCourtesy®, Inc. … in partnership with YOU for transportation

CONFIDENTIAL Statement of Need and Rider Information Form 888-447-7555

$10.00 Refundable Registration Fee if not accepted

Please mail to: PO BOX 19674, Atlanta, GA 30325 or FAX to: 404-745-8003

PLEASE ASSIST US BY PRINTING (EXCEPT SIGNATURE) ALL INFORMATION REQUESTED IN BALLPOINT PEN!

PLEASE COMPLETE ALL INFORMATION BEFORE SUBMITTING.

.

TODAY’S DATE: ______________________

FULL LEGAL NAME:__________________________________________________________

First Middle Initial Last

NICKNAME? _______________________________

PRESENT RESIDENCE ADDRESS:

______________________________________________________________________________

Number Street APT City State Zip

EMAIL: ___________________________________@________________

TELEPHONE ( ) ______-___________ Cell (Riders MUST carry a Mobile Phone for Safety)

(Please be as specific as possible below! )

Days/hours most likely to request transportation for your needs: Example: Thur__X__ Time 10am – noon

No Preference _______ Thur ________ Time __________

Mon __________ Time __________ Fri __________ Time _________

Tue __________ Time __________ Sat _________ Time __________

Wed _________ Time __________ Sun ________ Time __________

What are your most frequent needs for transportation? What Destination: frequency:

Approximate distance:

Next most frequent Destination: frequency:

Approximate distance:

Please state any information that you would like for us to know about you.

1)_______________________________________________________________________________

________________________________________________________________________________

Any SPECIAL NEEDS (CONFIDENTIAL)?

_____________________________________________________________________________

_

I CAN WALK FREELY yes/no I USE A WALKER yes/no I USE A WHEELCHAIR

yes/no

I NEED ASSISTANCE yes/no PLEASE EXPLAIN: __________________________________

Please list two nearby/available contacts or emergency numbers:

Name __________________________________________ Relationship

____________________

Telephone ______________________________________

Name __________________________________________Relationship

_____________________

Telephone ________________________________________

RELEASE OF LIABILITY PLEASE READ CAREFULLY! THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS!

The undersigned individual (the “Volunteer as Rider”), a Georgia resident, desires to obtain volunteer

automobile transportation through CommonCourtesy, Inc., a Georgia non-profit corporation, and

accordingly executes this Release of Liability (this “Release”). In consideration of the services performed

by CommonCourtesy, the Volunteer as Rider hereby freely and voluntarily executes this Release under the

terms below. I understand that this is “curb to curb service” only:

COMMON COURTESY CURB-TO-CURB RIDES FOR: HOW IT WORKS

A. Application

1. Become a registered rider by completing and submitting the required registration form along with a credit card or check for $10

made out to Common Courtesy

a. You must have a cell phone to become a registered rider

2. Receive Confirmation with your rider identification number and rider registration packet.

A. Taking Rides with Common Courtesy IF BY DISPATCH ONLY

1. Schedule a ride by calling the toll free message center at 888-447-7555 and pressing the #1 button on your phone. Leave a

message with all the information to arrange your ride from the script in your rider registration packet.

2. A confirmation call will be made providing you with a unique Ride Confirmation Code. Please retain this Code as it is your Ride

Confirmation and identification by Driver.

a. You will be given a local number to call 404-276-0164 on your cell if you have any changes to the planned travel itinerary.

Please write it down and take with you.

3. Pick-up Your Common Courtesy Driver will arrive within 10 minutes of the pick-up time, driver name and last 3 digits of their

license plate number will be provided to you along with make of the auto.

4. Return ride Common Courtesy will call you 15 minutes before you are scheduled to be picked up to confirm the time and location.

a. Please be sure and have your cell phone charged and turned on to receive the return ride confirmation call.

b. Call the local number given to you 404-276-0164 if your return time is delayed or changed.

c. Also call the local number if your driver has not arrived or if there is a problem.

5. Donations can be made to Common Courtesy by either mailing directly to them or leaving at Chapter site.

*If you are using you’re your own Smartphone: Please see the attached document for a step-by-step guide to Uber IT.

Common Courtesy is a not-for –profit organization offering rides to seniors. Rides are provided in association with Uber with Uber drivers.

Applications forms are available at the ______ office or from your Service Coordinator.

Help to provide safe, affordable or even no-cost transportation to those unable to operate a vehicle safely.

And…Our volunteer support needs are:

Your physical help to:

Administer and validate driver application procedures

Administer dispatch support

Give telephone responses to driver, riders, funding sources

Prepare materials and coordinate attendance for presentations

Data input, registering Drivers and Riders in the system

Prepare & assemble Fundraising & Grant Requests

Coordinate Volunteer Staff activities

Provide support as needed for Community Organizations

Advocacy

Track Funding and Accounting