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3. Eligible trips provided under the Senior Mobility Program are limited to the following <br />categories. Please indicate the categories of service to be provided by your program: <br />(check all that apply) <br />❑✓ Senior Center <br />❑✓ Nutrition <br />❑ Medical <br />Personal Care <br />Shopping <br />Social/Recreational (please list locations) <br />Local Museums, Parks, Beaches, Libraries,Theaters and County Fairs. <br />4. SNIP Guidelines restricts trips outside of Orange County to medical trips within <br />approximately 10 miles of the Orange County border. Do you intend to provide <br />medical trips outside of Orange County? 0 yes (�) No <br />If yes, please list the trip purpose and destinations: (e.g., medical trips to the VA Hospital <br />in Long Beach) <br />5. Fare structure: <br />Not Applicable <br />6. Number of vehicles: <br />3 <br />7. Projected annual ridership: <br />200 —� <br />8. Source(s) of 20 percent match funding: <br />City General Fund <br />19G-4 <br />