Skip to content
Trumbull County Provider Survey
I. ORGANIZATION CHARACTERISTICS AND SERVICES PROVIDED
The first set of questions will provide us with the general characteristics of your organization and the nature of the services provided.
Trumbull County is updating its Coordinated Public Transit-Human Services Transportation Plan, which seeks to develop strategies to address unmet transportation needs in the County. Please help us determine what the transportation needs are in Trumbull County by completing this survey.
If you have any questions regarding this survey, please contact Julie Schafer via email at jschafer@rlsandassoc.com or via telephone at (937)299-5007. You may also complete the survey online at
https://www.surveymonkey.com/r/TrumbullProvider
*
1.
Identification of Organization
(Required.)
Respondent's Name:
Title:
Organization:
Street Address:
City
State
Zipcode
Work Phone:
Fax:
Respondent's E-mail:
Respondent's Website Address:
*
2.
What are the major functions/services of your organization? (Select all of the following options that apply)
(Required.)
a. Transportation
b. Health Care
c. Social Services
d. Nutrition
e. Counseling
f. Day Treatment
g. Job Training
h. Employment
i. Rehabilitation Services
j. Diagnosis/Evaluation
k. Job Placement
l. Residential Facilities
m. Income Assistance
n. Screening
o. Information/Referral
p. Recreational/Social
q.Home Health Care
r. Housing
Other (please specify)
*
3.
Under what legal authority does your organization operate?
(Required.)
a. State government department
b .Private nonprofit organization
c. Private, for-profit
Other (please specify)
4.
What is the geographic area that your serve?
a. Anywhere within Trumbull County (yes or no)
b. Multiple Counties (please list):
c. Within city or town limits (please list):