Please complete this survey about your transportation needs and preferences. This information will be used in your local area's Coordinated Public Transit-Human Service Transportation Plan. For more information please contact RLS & Associates at (937) 299-5007. Thank you!

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* 1. What forms of transportation do you use: (check all that apply)

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* 2. If you use any transportation services, such as public transit or demand response/dial-a-ride, please tell us the name(s) of the services you use:

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* 3. What changes could be made to your local transportation options to make using them more appealing to you?

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* 4. Do you have difficulty getting the transportation you need to any of the following types of destinations?

  No difficulty Sometimes difficult Frequently difficult Always difficult Not applicable to me
Your employer
Medical offices, clinics or hospitals
Mental health care
Dental care
Pharmacy
Shopping
School
Human service agencies or government offices
Other trip purposes

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* 5. Do you need to travel to destinations outside of your county for work, medical care, shopping, or other reasons?

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* 6. Is it difficult for you to travel outside of your county? If yes, please indicate what makes it difficult.

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* 7. What is your age group? 

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* 8. Do you have a disability which requires you to use a cane, walker, wheelchair, and/or another device, or a service animal to help you get around?

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* 10. What is your zip code? 

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* 11. Do you have any comments or suggestions regarding the transportation services in your community?

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