1. I am age:

2.
I need transportation because:
(Check all that apply)

3. I need transportation for the following services:
(Check your top 5 choices)

4. I need to go to:
(Check your top 5 choices)

5.
In the past 3 months, I used the following means of transportation:
(Check all that apply)

6. Do you feel that the current transportation services available meet your needs and the needs of your community? 

7. Are you a:

8. Have you had to move to maintain independence?

9. Please indicate how often you need public transportation.

10. Indicate the day(s) of the week you need public transportation.

11. Indicate the time(s) of the day you need public transportation.

12. For mapping purposes only, please identify your pick-up location if you were to use transportation services: (Address or Crossroad, City, Zip Code)

13. Please indicate what kind of transportation services would improve your access to the following needs.
(Check all that apply)

  New Bus Route Extended Bus Hours Door-to-Door Bus Gas & Insurance Help None
Medical/Healthcare
Work
Community & Social services
Shopping
Social Activities

14.
Please write any additional comments regarding transportation services.

Thank you for completing this survey!


If you have any questions, please contact:

Sabrina Stoutamyer
PO Box 759
Ellensburg, WA 98926
sstoutamyer@pfp.org
Fax: (509) 925-1004

Please finish this survey by February 28, 2018.

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