Out of County Transportation Survey

Please complete and return survey no later than September 1, 2022

This survey will be used to gather information from residents of Columbiana County that need transportation outside of the county. The information will be used to find solutions to recognized transportation challenges and barriers.

Question Title

* 1. Do you or a family member need transportation outside of Columbiana County?

Yes, on a regular basis

Yes, occasionally

Question Title

* 2. Is your need of out of county travel for medical appointments or treatment?

Yes

Question Title

* 3. Is your need of out of county travel for employment or training?

Yes

Question Title

* 4. Is your need of out of county travel for school?

Yes

Question Title

* 5. Is your need of out of county travel for human or social service programs?

Yes

Question Title

* 6. Have you used public transportation in the past?

Yes

Question Title

* 7. Do you use any of the below devices to help you get around?

Cane

Walker

Wheelchair

Other (please specify)

None of the above

Question Title

* 8. What is your age category?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Question Title

* 9. Contact Information

Name

Address

Address 2

City/Town

State

ZIP

Email Address

Phone Number