2. Overview and Instructions

   You must have signed an electronic agreement with Pierce County on the Ride Together Pierce (RTP) trip calendar to use the Emergency Ride Home (ERH) program. Please only complete this form if you have paid for an Emergency Ride Home out-of-pocket, using a local taxi company, Uber or Lyft. Your reason for taking an Emergency Ride Home must be approved by Pierce County staff for you to receive a reimbursement.

   Once approved, reimbursements will be mailed to the employee directly within 3 weeks of receiving the Reimbursement Form.

   The RTP ERH program is available only for commutes to/from employment sites located in Pierce County. You can view our complete Program Rules here.

3. 
5. First Name*
7. Last Name*
9. Email Address*
11. Phone Number *
13. Employer Name*
15. Worksite Address*
17. Destination Address*
19. List name of intermediate stop, if needed (i.e., child’s school, pharmacy, daycare, ATM):
21. Which transportation mode was the longest portion of your commute on the day you took an ERH?*

    1. Carpool
    2. Vanpool
    3. Transit (bus, light rail or train)
    4. Walk
    5. Bike
23. Reason trip is requested*

    1. Unexpected personal or family illness.
    2. Unexpected request by a supervisor to work late (that is, the request comes on that same day, without prior notice or knowledge).
    3. Unexpected change in planned ride home (e.g., carpool driver had to leave early due to an emergency).
25. Please provide any additional information that will help with the approval process. Do not provide any information on medical conditions.*
27. Disclaimer:

    The RTP team reviews ERH requests for validity. Users who submit requests for non-eligible trip reasons will be notified. Users who are found to have submitted fraudulent ERH requests will be banned from the program.

29. Please upload a copy of your itemized receipt (pdf. png, jpg, doc):*
31. Mailing address to send the reimbursement check to:*
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

* indicates a required field