Elevated Access Collection Form

TRACTION is a hub partner with Elevated Access, a non-profit organization that enables people to access healthcare by providing flights on private planes at no cost. Our volunteer pilot network transports clients seeking abortion or gender-affirming care across the United States. In order to make your flight arrangements, we need to collect the information below. Elevated Access lets the passengers remain virtually anonymous. Pilots are only given the passenger’s first name and weight (to avoid exceeding a small aircraft’s weight limits). For more information about Elevated Access, visit https://www.elevatedaccess.org They also provide a helpful guide for passengers here: https://static1.squarespace.com/static/6467d799146f502ed383205b/t/6470466ef99df31e13439f76/1685079662577/Information%2Bfor%2BElevated%2BAccess%2BPassengers.pdf

Name of the practical support organization. If none, put n/a.
Who is submitting this request?
Your direct contact email address, not your organization’s general contact email address.
Signal communication is preferred.
City and state at least. For larger cities, please provide a ZIP code or an address of an innocuous nearby location such as a gas station or other business.
City and state at least. For larger cities, please provide a ZIP code or an address of an innocuous nearby location such as a gas station or other business.
Travel Date
What date this flight need to happen? Be sure to consider time for ground transportation to get to appointment, etc. after arriving at the airport. If the arrival time is before 10am, travel may need to happen the day prior.
Are there important times for us to know for this travel date? Examples include: time flight needs to arrive at the airport, time flight is able to depart, time pressures or flexibilities
If passenger needs to make the return trip on the same day, enter the expected number of hours the pilot will need to wait. If a return trip is needed on a different day, enter that as a separate flight request. If no return flight is needed, leave blank.
In pounds, with typical clothing including any coats and such for expected surface temperatures. All aircraft have to manage overall weight and balance to fly safely. Small airplanes like the ones Elevated Access volunteer pilots use need to know how much each passenger weighs and the weight of any baggage. For this reason, you need to be honest with your pilot and also only take the items you actually need for the journey. To balance the airplane, the pilot may ask you to sit in a specific seat rather than just offer you a seat of your preference.
Passenger Mobility
Are all passengers able to enter and exit the aircraft on their own? Passengers may have to step up onto a wing that is 16 to 20 inches above the ground, crouch slightly to fit through a small door, then lower themselves into the back seat.
In pounds. Should be less than 50 pounds and fit within a normal airline carry-on. If strollers, car seats, or similar items are necessary, they should be included in this weight.
What is the backup plan for this request if a volunteer pilot flight is not possible? We only need a general description such as “bus travel” or “car rental.”
Is there anything you think we should know about this passenger or their need? Is the date flexible? Is there more than one passenger? Will a service animal be involved? Do not include the purpose of the travel. If the passenger may have challenges communicating clearly and promptly with the pilot, please include that so we can do as much accommodation as possible.
Follow-Up Survey Question
Elevated Access would like to ask if their passengers are willing to participate in a survey for the purpose of quality improvement.
This field is for validation purposes and should be left unchanged.
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