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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 />Orange County Museums, Parks, Beaches, Llbraries,Theaters and County Fairs. <br />4 —SMT- Guide1ines res ricts trips�ici of range Coun o me ical -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 (F) 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 �ofvehicles; <br />I3 <br />7. Projected annual ridership: <br />2 ©O <br />8. Source (s) of 20 percent match funding: <br />City General Fund <br />.II <br />25B -12 <br />