Seniors Transportation Needs in Midway
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1. ITN Bluegrass May Expand Services to Midway

Midway Renaissance has prepared this survey in order to find out how many citizens in Midway may be interested in the services provided by ITN Bluegrass. Filling out the survey does not obligate you in any way.

1. Are you interested in possibly becoming a

Are you interested in possibly becoming a Rider

Driver

Both

2. If you are interested in becoming a Rider, are you

If you are interested in becoming a Rider, are you 60 years of age or older

Visually impaired

Both

3. What is your current mode of transportation? (i.e., my own car, taxi, bus, friend, family)

What is your current mode of transportation? (i.e., my own car, taxi, bus, friend, family)

4. What are your most frequent travel destinations?

What are your most frequent travel destinations?

5. How frequently do you travel?

How frequently do you travel?

6. Do you have any special needs? (i.e. use wheelchair, walker, cane)

Do you have any special needs? (i.e. use wheelchair, walker, cane)

*
7. We require your name and address in order to make this survey useful. Please provide your email address and/or phone number if you would prefer we contact you that way. Providing this information does not obligate you in any way. (Addresses are assumed to be Midway, KY 40347)

We require your name and address in order to make this survey useful. Please provide your email address and/or phone number if you would prefer we contact you that way. Providing this information does not obligate you in any way. (Addresses are assumed to be Midway, KY 40347) Name:
Street Address:
Mailing Address:
Email Address:
Phone Number:

8. How would you prefer to be contacted?

How would you prefer to be contacted? Mail

Phone

Seniors Transportation Needs in MidwayExit this survey