Organization

Please provide the following information regarding your organization.

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* 1. Organization Information

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* 2. Please describe the geographic area you serve.

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* 3. What type of agency is your organization?

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* 4. Which clients does your agency provide service? (Check all that apply)

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* 5. What age group are your services designed for? (Check all that apply)

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* 6. Does your agency serve people with mobility limitations? (Mobility limitations are physical, mental, or other conditions that limit their ability or cause difficulty in getting to places they need or want to go)

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* 7. Please identify the types of mobility limitations: (check all that apply)

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* 8. Which days per week do you regularly need transit services? (Check all that apply)

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* 9. What hours of the day do your clients need access to transportation services? Please indicate using AM and PM -i.e. 9:30AM

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* 10. How many weeks per year do your clients regularly need transit service?

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