4 County Community Transportation Planning Team

Question Title

* I need transportation because: (Choose all that apply.)

I am an elder or senior citizen, and I don't drive

I am disabled

I am homeless

I am too ill to drive

I don't have a car

I don't have a driver's license

I don't have auto insurance

I am not old enough to drive

Other (please specify)

Question Title

* I currently use the following means for transportation: (Choose all that apply)

Medical(Coupon)Transportation

GTA Transit

My Vehicle

People For People

Senior Services Transportion

Taxi Service

Family, Friends, or Volunteers

Other service provider makes available bus pass, gas voucher or other form of service

Other (please specify)

Question Title

* I need transportation to: (Number your top 3 choices)

	First Choice	Second Choice	Third Choice
Banking	Banking First Choice	Banking Second Choice	Banking Third Choice
Childcare	Childcare First Choice	Childcare Second Choice	Childcare Third Choice
Community Events	Community Events First Choice	Community Events Second Choice	Community Events Third Choice
Court Appointments	Court Appointments First Choice	Court Appointments Second Choice	Court Appointments Third Choice
Dental	Dental First Choice	Dental Second Choice	Dental Third Choice
Drug/Alcohol Treatment	Drug/Alcohol Treatment First Choice	Drug/Alcohol Treatment Second Choice	Drug/Alcohol Treatment Third Choice
Education	Education First Choice	Education Second Choice	Education Third Choice
Friends and Family	Friends and Family First Choice	Friends and Family Second Choice	Friends and Family Third Choice
Food Bank	Food Bank First Choice	Food Bank Second Choice	Food Bank Third Choice
Grocery Shopping	Grocery Shopping First Choice	Grocery Shopping Second Choice	Grocery Shopping Third Choice
Job Training	Job Training First Choice	Job Training Second Choice	Job Training Third Choice
Medical Appointments	Medical Appointments First Choice	Medical Appointments Second Choice	Medical Appointments Third Choice
Elder/Senior Services	Elder/Senior Services First Choice	Elder/Senior Services Second Choice	Elder/Senior Services Third Choice
Pharmacy	Pharmacy First Choice	Pharmacy Second Choice	Pharmacy Third Choice
Physical Therapy	Physical Therapy First Choice	Physical Therapy Second Choice	Physical Therapy Third Choice
Recreational Facilities	Recreational Facilities First Choice	Recreational Facilities Second Choice	Recreational Facilities Third Choice
Social Service Appointments	Social Service Appointments First Choice	Social Service Appointments Second Choice	Social Service Appointments Third Choice
Vocational Rehabilitation	Vocational Rehabilitation First Choice	Vocational Rehabilitation Second Choice	Vocational Rehabilitation Third Choice
Work	Work First Choice	Work Second Choice	Work Third Choice
WorkSource Appointments	WorkSource Appointments First Choice	WorkSource Appointments Second Choice	WorkSource Appointments Third Choice

Other (please specify)

Question Title

* I need to go to: (Number your top 3 choices)

	1	2	3
Benge	Benge 1	Benge 2	Benge 3
Cunningham	Cunningham 1	Cunningham 2	Cunningham 3
Ellensburg	Ellensburg 1	Ellensburg 2	Ellensburg 3
Hatton	Hatton 1	Hatton 2	Hatton 3
Lind	Lind 1	Lind 2	Lind 3
Moses Lake	Moses Lake 1	Moses Lake 2	Moses Lake 3
Othello	Othello 1	Othello 2	Othello 3
Pasco	Pasco 1	Pasco 2	Pasco 3
Quincy	Quincy 1	Quincy 2	Quincy 3
Ralston	Ralston 1	Ralston 2	Ralston 3
Richland	Richland 1	Richland 2	Richland 3
Ritzville	Ritzville 1	Ritzville 2	Ritzville 3
Royal City	Royal City 1	Royal City 2	Royal City 3
Spokane	Spokane 1	Spokane 2	Spokane 3
Stratford	Stratford 1	Stratford 2	Stratford 3
Warden	Warden 1	Warden 2	Warden 3
Washtucna	Washtucna 1	Washtucna 2	Washtucna 3
Wenatchee	Wenatchee 1	Wenatchee 2	Wenatchee 3
Yakima	Yakima 1	Yakima 2	Yakima 3

Question Title

* Other

Question Title

* I need transporation on the following days of the week: (Choose all that apply)

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Question Title

* I need transportation at the following times: (Choose all that apply)

Morning

Afternoon

Evening

Question Title

* Do you know what current transportation services are available for you?

Yes

Question Title

* Do you use transportation services that are available to you?

Yes

If no, why not

Question Title

* If you currently use transportation services, are they meeting your needs?

Yes

If no, how can it be improved