Sponsored by:  Keokuk Human Rights Commission & SEIBUS

March - May, 2018

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* 1. Do you have your own vehicle to get to and from work, appointments or shopping?

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* 2. Do you need special accommodation for Transportation ( i.e.: Wheelchair Lift)

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* 3. Do you have a driver’s license?

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* 4. Do you use your vehicle to get to work?

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* 5. If you don’t have your own vehicle, how do you get to work, appointments or shopping? Select all that apply and provide the average number of days per week for each category

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* 6. How far do you live from work?

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* 7. Are you a temporary employee?

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* 8. Please enter days and times of the week you need transportation services for work, appointments or shopping

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* 9. If public transit bus, volunteer-run van or shuttle service existed at the times you need to get to and from work, appointments, and shopping would you personally use it? ( Check the one that best Applies to You)

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* 10. Please provide any additional comments or suggestions to improve overall transportation services for you:

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