Please note: Any information provided using this form constitutes a public record and may be subject to public disclosure.

Thank you for taking time to provide feedback about this program!

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* 1. Contact information

The following two questions refer to 2016

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* 2. Amount requested (in dollars)

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* 3. Amount awarded (in dollars)

The following two questions refer to 2015

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* 4. Amount requested (in dollars)

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* 5. Amount awarded (in dollars)

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* 6. Years your agency was allocated bus tickets (check all that apply)

How many clients do you anticipate serving with bus tickets:

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* 7. This year

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* 8. This month

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* 9. How does the bus ticket program complement your other services?

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* 10. Do you anticipate exhausting your supply of tickets before the end of the year?

If you answered No, please move to Question No. 14.
If you answered Yes, please respond to the following questions:

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* 11. In which month do you anticipate running out?

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* 12. How many more tickets could your organization use this year?

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* 13. If this number of additional tickets were available, would your organization have sufficient resources to pay the 20% of ticket value match?

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* 14. What is your experience with the program’s current compliance and reporting requirements?

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* 15. What is your organization’s overall experience using the program? Is the program easy to access and use?

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* 16. If you could make any changes to the program, what would you change?

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