Transportation Survey

I need transportation because: (Check all that apply.) I am a senior citizen or elderly and don't drive I am disabled I am homeless I am too ill to drive	I do not have a car I do not have a driver's license I do not have auto insurance I am not old enough to drive
Other (please specify)

I use the following means of transportation: (Check all that apply.) Medical Transportaion (coupon) Pierce Transit bus Pierce Transit Shuttle Taxi service Road to Independence (TANF)	My own vehicle Family or friends Volunteer driver (Catholic Community Services) Beyond the Borders Other service provider
Other (please specify)

I need transportation to: (Check your top three destinations.) Banking Child care Community events Court appointments Dental Dialysis Drug/alcohol treatment Family or friends	Food bank Grocery shopping Job training Meal sites Medical appointments Pharmacy Physical therapy	Recreational facilities School Social service appointments Vocational rehabilitation Work WorkSource appointments
Other (please specify)

I need to go to: (Check your top three locations.) Bonney Lake Buckley Burnett Carbonado Eatonville Gig Harbor Home	Kapowsin Key Center McKenna Olympia Orting Roy Seattle	Spanaway South Prairie Sumner Tacoma Wilkeson
Other (please specify)

Please provide the address for your top three destinations. A.
B.
C.

Do you know what transportation choices are available for you? Yes

If you currently use transportion services, do they meet your needs? Yes

Would tranportation improve your ability to meet your needs for: Medical or health care

Employment opportunities

Shopping or daily activities

Social or community events

For mapping purposes only, please provide your pickup location. (Street address, city and zip code)

If you would like us to contact you about transportation resources please provide your name and phone number.

Transportation Survey - RidersExit this survey