+ {% blocktranslate trimmed %} + The Santa Barbara Metropolitan Transit District issues Mobility Pass cards to eligible riders. This transit benefit may need to be renewed in the future based on the expiration date of the Mobility Pass. Learn more at the SBMTD Fares & Passes. + {% endblocktranslate %} +
diff --git a/benefits/eligibility/forms.py b/benefits/eligibility/forms.py index 02844377c..eb9264fb9 100644 --- a/benefits/eligibility/forms.py +++ b/benefits/eligibility/forms.py @@ -156,3 +156,26 @@ def __init__(self, *args, **kwargs): *args, **kwargs, ) + + +class SBMTDMobilityPass(EligibilityVerificationForm): + """EligibilityVerification form for the SBMTD Mobility Pass.""" + + def __init__(self, *args, **kwargs): + super().__init__( + title=_("Agency card information"), + headline=_("Let’s see if we can confirm your eligibility."), + blurb=_("Please input your Mobility Pass number and last name below to confirm your eligibility."), + name_label=_("Last name (as it appears on Mobility Pass)"), + name_placeholder="Garcia", + name_help_text=_("We use this to help confirm your Mobility Pass."), + sub_label=_("SBMTD Mobility Pass number"), + sub_help_text=_("This is a 4-digit number on the front and back of your card."), + sub_placeholder="1234", + name_max_length=255, + sub_input_mode="numeric", + sub_max_length=4, + sub_pattern=r"\d{4}", + *args, + **kwargs, + ) diff --git a/benefits/eligibility/templates/eligibility/includes/media-item--idcardcheck--start--sbmtd-mobility-pass.html b/benefits/eligibility/templates/eligibility/includes/media-item--idcardcheck--start--sbmtd-mobility-pass.html new file mode 100644 index 000000000..50aa2ceba --- /dev/null +++ b/benefits/eligibility/templates/eligibility/includes/media-item--idcardcheck--start--sbmtd-mobility-pass.html @@ -0,0 +1,15 @@ +{% extends "eligibility/includes/media-item--idcardcheck.html" %} + +{% load i18n %} + +{% block heading %} + {% translate "Your current Mobility Pass number" %} +{% endblock heading %} + +{% block body %} ++ {% translate "You do not need to have your physical card, but you will need your four-digit Mobility Pass number on the back of the card." %} +
+