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1. I am age:

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

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3.
I need transportation because:
(Check all that apply)

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

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

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

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7. Have you had to move to maintain independence?

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8. Please indicate how often you need public transportation.

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

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

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

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12. 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

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13.
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 March 27, 2018.

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