Thank you for participating in this short survey. The information you provide will be used to update the Coos County Veterans Transportation Needs Assessment. Please fill out each question to the best of your ability. Thank you for your participation. All surveys will be kept anonymous.

Disclaimer: Please only take this survey if you are a United States Military Veteran living in Coos County, Oregon. We also ask that you do not fill out this survey if you have already done so.

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* 1. What is your age?

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* 2. What is your gender?

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* 3. In which branch(es) of the military did you serve? Select all that apply.

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* 4. In what war era(s) did you serve? Select all that apply.

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* 5. Do you have a disability, and is it service connected

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* 6. Do you receive healthcare from the VA?

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* 7. If you do receive VA healthcare, approximately how many times do you

go?

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* 8. If you receive VA healthcare, at what location? Select all that apply.

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* 9. Please list your 3 most traveled destinations. (Examples: VA Roseburg,
Work, School, Grocery Store, Case Management, etc.)

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* 10. Please select every type of transportation you have used in the past 6 months.

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* 11. What are your top 3 most used transportation modes? (ex: Bus, 
Personal Vehicle, Taxi, Walk, etc.)

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* 12. What are the biggest challenges you experience with transportation? 
(Examples: Cost, getting to work, uncomfortable with bus, etc.)

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* 13. What type of technology do you use to go on the Internet? Mark all that apply.

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* 14. What other sources do you use to get information about transportation? Select all that apply.

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* 15. Please list the specific websites that you use to find information about 
transportation or Veteran human services.

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* 16. What describes the most important factor in choosing a transportation 
mode? (Example, convenience, cost, handicap accessible, etc. )

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* 17. What types of transportation assistance would be valuable to you?

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* 18. If Coos County Area Transportation District did not receive funding for Veteran Transportation Services, how would that impact you?

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* 19. Is there anything you would like to add that you feel would be helpful in meeting your transportation needs?

0 of 19 answered
 

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