Lee County Transportation Survey Please complete the following survey to help the Lee County Transportation Taskforce better serve the community. Your answers will be kept confidential. If you have questions about this survey, please contact Nicole Baker, SEIBUS Transit Director at 1-866-753-5107 Question Title * 1. Please provide your zipcode Question Title * 2. Please provide your age Under 18 years 18-25 years 26-34 years 35-44 years 45-54 years 55-64 years 65-74 years 75 years-84 years 85 years or more Question Title * 3. Do you receive the elderly waiver? Yes No Question Title * 4. Do you receive Medicaid benefits? Yes No Question Title * 5. Do you have a driver's license? Yes No Question Title * 6. If you own a vehicle, is it insured? Yes No Question Title * 7. Please rate the reliability of your vehicle Unreliable Sometimes reliable Reliable Very reliable I do not own a vehicle Question Title * 8. Check which towns you need to get to regularly but have problems with transportation Donnellson Fort Madison Keokuk West Point Other (please specify) Question Title * 9. How likely would you be to use a bus service schedule twice a month each to the towns listed above? Very likely to use 1 time or more a month Somewhat likely to use 1 time a month May use a few times a year Not likely to use Question Title * 10. How much would you be able/willing to pay for this service, round trip? $10 $15 $20 I cannot pay but I need this service I don't need this service Question Title * 11. Please select the three locations most important to you City Hall Library Food pantry Post office DHS Church Work Big box retailer (ShopKo, Wal-Mart) Parks Senior Center WIC Grocery Store Bank K-12 School College Medical/Dental Other (please specify) Question Title * 12. If you are interested in transportation to/from work, which times/days would you need a ride? Question Title * 13. Where do you currently work? Please list name of employer and town Next