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North Central Human Services Plan Public Survey
*
1.
Please provide your city/town and zip code
(Required.)
City/Town
Zip Code
2.
What is your age?
Under 16 years
16 to 20 years
21 to 34 years
35 to 44 years
45 to 59 years
60 to 64 years
65 to 74 years
75 years and over
3.
What is the highest level of education you have completed?
Some high school
Graduated from high school
Some college
Technical School
Bachelor's degree
Master's degree
Doctoral degree
4.
What is your annual household income?
Less than $15,000
Between $15,000 and $24,999
Between $25,000 and $34,999
Between $35,000 and $49,999
Between $50,000 and $74,999
Between $75,000 and $99,999
Between $100,000 and $149,999
$150,000 or more
5.
Are you a military veteran?
Yes
No
6.
Do you have any type of disability?
Yes
No
7.
How many children under 18 live with you?
No Children
One Child
Two Children
Three Children
More than three Children
8.
Do you have access to a car?
Yes, I own a car and drive myself
Yes, a family member or friend has a car and drives me
Yes, I borrow a car and drive myself
No, I do not have access to a car
9.
What are the top 3 destinations you want to go to but cannot due to lack of transportation?
Destination 1
Destination 2
Destination 3
10.
For the majority of your local trips, how do you travel? (Check all that apply)
I drive myself
Use public transportation (ATA, etc.)
Ride in family / friend's vehicle
Ride with volunteers / carpool
Take a taxi
Walk / bike
Use a human service agency (Health-ride, nursing home, etc.)
Other, please list:
11.
Based on your experiences, please tell us which of the following challenges you have encountered using transportation services. (Check all that apply)
Understanding program requirements
Knowing what’s available
Unable to travel to transportation facilities
Cost of transportation
Difficulty connecting to other services
Limited geographic coverage
Operating hours of service
12.
Please list the local services that you use. (ATA, senior center shuttle, etc.)
13.
Please indicate your reasons if you have never used or no longer use public
transportation. Check all that apply.
Service is not frequent enough
Travel takes too long
Service is not offered to the sites I need
Service is not reliable
Fares are expensive
Too far to walk to a bus stop
I prefer to drive
I am not aware of the services available
Not applicable
Other (please specify)
14.
Have you considered relocating to an area with better transportation services? (i.e. move closer to town, hospitals, or a location that has more options to better suit your needs)
Yes
No
15.
How do you find transportation services available to you? (Check all that apply)
Senior Center
Word of Mouth
Internet Search
Program Contact
County Assistance Office
PA211
Other (please specify)
16.
During the past year, what portion of your transportation did you drive yourself?
0%
50%
100%
Clear
17.
During the past year, what portion of your transportation did your friends/family drive you?
0%
50%
100%
Clear
18.
During the past year, what portion of your transportation did local services drive you? (ATA, health provider, etc.)
0%
50%
100%
Clear
19.
What portion of your transportation would you like local services (ATA, health provider, etc.) to drive you?
0%
50%
100%
Clear
20.
How much do you currently pay per one-way trip for public transportation? (This does not include rideshare trips)
Nothing
Less than $1.00
$1.00 - $1.50
$1.50 - $2.00
More than $2.00
21.
How much are you willing to spend on a one-way trip for public transportation? (This does not include rideshare trips)
Nothing
Less than $1.00
$1.00 - $1.50
$2.00 - $2.50
More than $2.50
22.
If you already use or were going to use public transportation, what is you main reason for traveling? Please check one.
Work
Medical appointments
Shopping
Family / friend visits
Entertainment
Social service
Education
Religious
Not Applicable
Other (please specify)
23.
When you travel, how long does it typically take you to get to your destination?
0 Minutes
50 Minutes
100 Minutes
Clear
24.
How long do you wait for transportation when returning home?
0 Minutes
50 Minutes
100 Minutes
Clear
25.
Please indicate the hours you most frequently travel or need to travel.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
12 A.M - 6 A.M.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
6 A.M - 8 A.M.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
8 A.M. - 12 P.M.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
12 P.M. - 3 P.M.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
3 P.M - 6 P.M.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
6 P.M. - 9 P.M.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
9 P.M. - 12 A.M.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Other (please specify)
26.
In the last six months, have any household members missed any of the following due to a lack of transportation? Please check all that apply.
Work
Medical appointments
Shopping
Family / friend visits
Entertainment
Social service
Education
Religious
Not Applicable
Other (please specify)
27.
What government services do you participate in? (Check all that apply)
Medicaid (Medical Assistance)
Medicare
Supplemental Nutritional Assistance Program (SNAP)
Area Agency on Aging (AAA)
Housing Assistance (HUD)
Temporary Assistance for Needy Families (TANF)
Childcare Subsidy (CCIS)
Veterans Affairs (VA)
Head Start
CareerLink or other employment program
None
Other (please specify)
28.
Which of the following would be the best way to inform you about transportation services in your community? Check all that apply.
Direct mailings to your home
Newspaper
Radio
Television
Websites
Social media
Inserts with your municipal bills
Not interested
Other (please specify)
29.
What are some of your suggestions to improve transportation services?
30.
If you would like us to keep you informed about additional opportunities for you to provide feedback, please provide your email address below.