Chemung County, NY · Chemung County
Individual Access Pass Application
New York State residents with qualifying disabilities use this application to request an Individual Access Pass for eligible parks, historic sites, and recreation facilities.
At a glance
- Issued by
- City of Chemung County · Chemung County, Chemung County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- chemungcountyny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
The application requests an Individual Access Pass, which provides eligible New York State residents with qualifying disabilities free or discounted use of certain state parks, historic sites, and recreational facilities. Applicants complete personal and residency information and provide proof of residency and a photo. They must also provide an organization certification or have a physician complete the certification section.
Who needs it
New York State residents with a qualifying disability who want to apply for an Individual Access Pass should complete this application.
How to submit it
Mail the completed application and all required materials to Access Pass, New York State Parks, Albany, NY 12238. The form says applications cannot be processed on site at any location.
About notarization
This application is signed without a notary; the applicant signs and dates the authorization, and a physician signs only when completing the physician certification.
How to submit this form
- 1
Download the Application
Download the Individual Access Pass application.
- 2
Complete Applicant Information
Fill in the applicant information and complete the authorization and certification.
- 3
Gather Required Materials
Include proof of residency, a passport-size photo, and organization certification or physician certification.
- 4
Mail the Application
Mail the completed application and materials to Access Pass, New York State Parks, Albany, NY 12238.
Frequently asked questions
- Who can apply for an Individual Access Pass?
- A New York State resident with a disability that meets the application’s qualifications may apply. The form describes organization and physician certification options.
- What should I include with the application?
- Include proof of New York State residency, a passport-size photo, and either the required organization certification or a physician-completed certification section.
- Do I need a notary for the Individual Access Pass application?
- No. The applicant signs and dates the authorization; a physician signs only if completing the physician certification. Neither signature requires a notary.
- How do I submit the Individual Access Pass application?
- Mail the completed application and required materials to Access Pass, New York State Parks, Albany, NY 12238. The form says it cannot be processed on site.