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1. Please provide your city/town and zip code (Required.)

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2. What is your age?

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3. What is the highest level of education you have completed?

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4. What is your annual household income?

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5. Are you a military veteran?

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6. Do you have any type of disability?

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7. How many children under 18 live with you?

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8. Do you have access to a car?

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9. What are the top 3 destinations you want to go to but cannot due to lack of transportation?

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10. For the majority of your local trips, how do you travel? (Check all that apply)

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11. Based on your experiences, please tell us which of the following challenges you have encountered using transportation services. (Check all that apply)

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12. Please list the local services that you use. (ATA, senior center shuttle, etc.)

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13. Please indicate your reasons if you have never used or no longer use public
transportation. Check all that apply.

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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)

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15. How do you find transportation services available to you? (Check all that apply)

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16. During the past year, what portion of your transportation did you drive yourself?

0% 50% 100%
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i We adjusted the number you entered based on the slider’s scale.

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17. During the past year, what portion of your transportation did your friends/family drive you?

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i We adjusted the number you entered based on the slider’s scale.

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18. During the past year, what portion of your transportation did local services drive you? (ATA, health provider, etc.)

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i We adjusted the number you entered based on the slider’s scale.

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19. What portion of your transportation would you like local services (ATA, health provider, etc.) to drive you?

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i We adjusted the number you entered based on the slider’s scale.

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20. How much do you currently pay per one-way trip for public transportation? (This does not include rideshare trips)

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21. How much are you willing to spend on a one-way trip for public transportation? (This does not include rideshare trips)

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22. If you already use or were going to use public transportation, what is you main reason for traveling? Please check one.

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23. When you travel, how long does it typically take you to get to your destination?

0 Minutes 50 Minutes 100 Minutes
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i We adjusted the number you entered based on the slider’s scale.

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24. How long do you wait for transportation when returning home?

0 Minutes 50 Minutes 100 Minutes
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i We adjusted the number you entered based on the slider’s scale.

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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.
6 A.M - 8 A.M.
8 A.M. - 12 P.M.
12 P.M. - 3 P.M.
3 P.M - 6 P.M.
6 P.M. - 9 P.M.
9 P.M. - 12 A.M.

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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.

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27. What government services do you participate in? (Check all that apply)

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28. Which of the following would be the best way to inform you about transportation services in your community? Check all that apply.

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29. What are some of your suggestions to improve transportation services?

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30. If you would like us to keep you informed about additional opportunities for you to provide feedback, please provide your email address below.

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