* 1. How do you usually travel to:

  Car/Truck/SUV Bike Walk Bus Paratransit Not Applicable
Work
School
Shopping
Leisure

* 2. Do you or members of your family have difficulty reaching certain places due to a lack of transportation?

* 3. Is there a bus stop near your home? (If you answer no or I don't know to the question below, skip to question #6 to continue.)

* 4. If you answered yes to the previous question, does this stop have (check all that apply):

* 5. If the bus stop closest to your house has sidewalks leading to it, check all that apply to those sidewalks:

* 6. What would help you take more independent trips on a fixed-route bus? (check all that apply.)

* 7. Do you currently ride the bus or paratransit?

* 8. If you answered no to the previous question, indicate why you do not ride the bus or paratransit. (check all that apply.)

* 9. If you indicated in the previous question that you do not feel safe taking the bus and paratransit, provide a short explanation including what would need to change to help you feel safe.

* 10. If you answered yes to question #7, why do you use the bus or paratransit (check all that apply).

* 11. Do you use a mobility device?

* 12. If you answered yes to the previous question, what type of mobility device do you use?

* 13. What is your age?

* 14. What is your zip code?

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