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MAS Transportation Questionnaire
Missoula Aging Services (MAS) is looking to identify community transportation needs so that we can work towards providing or improving services. We appreciate any information that you can provide. Your information will remain confidential.
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1.
What age range are you?
18-39
40-59
60-74
75-89
90-100
Over 100
2.
Please describe your current state of health:
Excellent
Fair
Poor
3.
What is your household composition?
Live alone
Live alone with caregiver support
Live with roommate(s)
Live with partner
Live with family
4.
Please check your annual household income range:
Under $12,900
$12,901 to $17,400
$17,401 to $21,960
Over $21,960
5.
What is your current housing situation?
Rent
Own home with mortgage
Own home with no mortgage
Live with family or friend (pay no rent)
Currently without stable housing
6.
Are you a veteran?
Yes
No
7.
What is the zip code of your current residence?
8.
What is your race/ethnicity?
African American/Black
Asian/Asian American
Hispanic/Latinx
Two or More Races
Native American or Alaska Native
Native Hawaiian or other Pacific Islander
White/Caucasian (non-Hispanic)
9.
What is your most consistent mode of transportation?
Drive personal vehicle
Mountain Line Bus
Mountain Line Paratransit
Mountain Line Shuttle Van
Rely on friends, relatives, neighbors
Paid caregiver
Walk or bike
Paid service: Uber/Lyft/Taxi
Other (please specify)
10.
If you don’t drive a car, why not?
Can’t drive due to a medical/physical condition
Can’t afford a car
Can’t afford gas/insurance/car repairs or upkeep
Lost driver’s license
No need, everything I need I can access without a car
Not applicable
Other (please specify)
11.
If you don’t drive, how reliable are the people or organizations that provide rides?
Always reliable
Usually reliable
Sometimes reliable
Seldom reliable
Never reliable
Not applicable
12.
What prevents you from traveling outside your home? Check all that apply
No car
No one to drive me
Don't feel safe
No accessible transportation services
Not applicable
Other (please specify)
13.
What is your confidence level when traveling? (This could be driving, riding with someone else, and/or using public transportation)
Completely confident
Fairly confident
Somewhat confident
Slightly confident
Not confident at all
14.
What transportation programs are you aware of? Check all that apply
Bus
Paratransit
Shuttle Van
Iride Vanpool
Uber/Lyft/Taxi
Other (please specify)
15.
Have you tried to use Mountain Line services? (Bus, Paratransit, Shuttle Van)
Yes
No
If yes, which one?
16.
Is your home in the service area for Mountain Line?
Yes
No
I don't know
17.
What prevents you from using public transportation? (Bus, Paratransit, Shuttle Van) Check all that apply
Times
Don't feel safe
Health reasons
Poor access
Not provided where I live/not offered to desired destinations
Takes too long
Not reliable
Do not know how to use it
Have my own means of transportation
Not applicable
Other (please specify)
18.
In an average week, how many vehicle trips do you take?
None
1-5
6-10
11-15
16-20
More than 20
19.
If you had additional transportation options, how many more trips would you take per week?
None
1-5
6-10
11-15
16-20
More than 20
20.
If you had better access to transportation would your quality of life:
Improve
Stay the same
Decrease
21.
What times would you need to use a transportation service the most?
6am to 9am
9am to 12 noon
12 noon to 4pm
4pm to 7pm
7pm to 10pm
10pm-6am
22.
What days of the week would you be most likely to travel using a transportation service?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
23.
Do you need any of the following kinds of assistance when you travel? Check all that apply
Assistance getting ready to leave home
Assistance getting into and out of a vehicle
Escort to accompany you
Help loading and unloading packages
Wheelchair, lift or ramp
Space for a wheelchair
Service animal
I do not need any assistance
Other (please specify)
24.
What type of service would be most helpful?
Having someone accompany you while traveling
Having someone help you learn how to use Mountain Line services
Specific route with vehicle stopping at set locations along the way
Pick you up at sidewalk and drop off at sidewalk of destination
Pick up at front door and take you to the entryway of destination
Go inside to pick you up and take you through the door to inside your destination
Not applicable
25.
How much would you be willing/able to pay a transportation service?
26.
What would you use a transportation service for? Check all that apply
Getting to medical appointments
Grocery shopping
Social activities
Personal errands
Not applicable
Other (please specify)
27.
If your transportation needs are met, would you be interested in volunteering to assist others with transportation?
Yes
No
28.
Would you like to be entered into a drawing for a $25 Visa gift card? Please provide your name and contact information:
29.
If you have any questions, would like to discuss your transportation needs or are interested in volunteering, please provide your name and phone number here and MAS staff will follow-up with you:
Current Progress,
0 of 29 answered
