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Rural General Public (RGP) Application (For First-time Applicants Only)

  1. For transportation requests to medical appointments, please read the following before submitting this form:  

    1.  If you receive Medicaid benefits, do not use this form.  Call Medicaid transportation at 910-878-4041 to schedule your ride.  

    2.  If you receive Managed Care benefits such as WellCare, United Health Care, etc., do not use this form.  Please schedule your ride with your provider.

    3.  If neither of the situations above applies to you, you may continue with this form.

  2. Passenger Assistance Codes*
    (Choose all that apply)
  3. Race/Ethnicity

    (Complete this section if you are seeking routine transportation.  All transportation requests must be submitted by 11am one business day prior to when you want to start.  All requests received after 11am will not be available for the next business day, but will be available for starting the following business day.)

  6. Days of Service
    (Check all that apply)
  7. Leave This Blank:

  8. This field is not part of the form submission.