Thanks for your support on this regional safety study, which will help us identify safety risks in the region.

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* 1. Do you spend time in McDowell County? (Select all that apply.)

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* 2. Do you spend time in Rutherford County? (Select all that apply.)

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* 3. Do you spend time in Polk County? (Select all that apply.)

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* 4. How often do you currently travel within or from the three-county region to work/school/recreation using the following modes of transportation? Please place a check in the box that applies to you.

  3 or more days/week 1-2 days/week 1-3 times/month Less than once/month Never
Drive alone
Carpool
Walk
Bike
Other

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* 5. What are your top 3 concerns for roadway safety? (Select up to 3.)

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* 6. What physical safety improvements would you support or prioritize? (Select up to 3.)

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* 7. If you would like to share your experience with roadway safety, or share a personal story of a traffic crash in the region that affected you or your family, please write them in the box below.

Demographic Questions (Optional)

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* 8. What is your home zip code? (Fill in the blank.)

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* 9. What is your age category?

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* 10. What is your gender?

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* 11. What is your ethnicity?

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* 12. What is your race?

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