Section 1: General Information

Please complete the Practice Description below and provide as much detail as you can regarding the setting in which the practice is implemented. We are especially interested in any information you can provide regarding the impact of this practice. NCMM is building mobility management community profiles, and our interest is in helping communities implement practices that hold promise regarding enhancing high quality mobility options. Information about the context and conditions under which the practice is implemented will assist other communities to make informed decisions about the applicability of a particular practice within their own setting.

NCMM developed six criteria or characteristics of a practice (innovation, knowledge base, stakeholder engagement, monitoring and evaluation, efficiency, and impact) that provide an assessment of the potential promise of that practice. The details that you provide regarding these six criteria will assist NCMM in identifying those practices that have an increased likelihood of impact.

A description of practices, along with other demographic information about a community, will be available in a searchable database, the Mobility Management Information and Practices (MMIP) Database. We hope you will consider sharing your practices. If you would like to talk with us about the MMIP or your practices please contact, Julie Rosekrans at jrosekrans@easterseals.com or Judy Shanley at jshanley@easterseals.com.

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* 1. Name of person providing information:

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* 2. Title of person providing information:

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* 3. Phone Number (ex: 555.555.5555):

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* 4. Email Address:

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* 5. Lead organization or agency implementing the practice:

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* 6. Type of organization or agency:

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* 7. In which FTA region are you located?

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* 8. City:

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* 9. State (ex: NJ):

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* 10. Zipcode (ex: 12345):

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* 11. County (please list all counties or states that the practice serves):

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* 12. Demographics:

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* 13. Do you have a mobility management program or system?

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* 14. Do you have a mobility manager or a person who coordinates services and/or practices?

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