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1. What is your name? (optional, we may just have additional clarifying questions or updates down the road)

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2. What is your department?

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3. How do you currently get to work?

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4. Approximately how much is your annual pay (before taxes)?

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5. How many days do you work each week, on average?

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6. How many miles each way is your commute to/from work?

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7. How big of a concern are rising fuel prices for you and your family?

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8. If relevant, how have rising gas prices impacted you and your family?

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9. If gas prices stay around $5 or rise higher in the next few months, how would that impact you/your family?

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10. If relevant, is there a reason you can't use public transportation or carpooling to get to work?

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11. Which, if any, of the following options would help you/your family address the impact of rising gas prices?

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12. Do you have any other comments about fuel prices or how the City can support families during this time?

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