Faulkton Area Transportation Survey What Town or County do you live in? Question Title * 1. What Town or County do you live in? OK Please check the age classification you fit into Question Title * 2. Please check the age classification you fit into 60 or over 19-60 Over 60 with a disability 19-60 with a disability under 19 OK Do you have any form of transportation? Question Title * 3. Do you have any form of transportation? OK Do you need transportation? Question Title * 4. Do you need transportation? OK Do you need wheelchair transportation? Question Title * 5. Do you need wheelchair transportation? OK Have you ever used public transportation? Question Title * 6. Have you ever used public transportation? OK What did you use public transportation for? Question Title * 7. What did you use public transportation for? OK What was your experience or opinion of your public transit ride? Question Title * 8. What was your experience or opinion of your public transit ride? OK Would you use public transportation if it were available and affordable? Question Title * 9. Would you use public transportation if it were available and affordable? OK Do you know anyone who needs transportation? Question Title * 10. Do you know anyone who needs transportation? OK Do you have access to out of town appointments? Question Title * 11. Do you have access to out of town appointments? OK (Please check all that apply) Transportation need for in-town/out-of-town: Question Title * 12. (Please check all that apply) Transportation need for in-town/out-of-town: In-town medical In-town nutrition in-town shopping out-of town medical out-of-town nutrition out-of-town shopping Other (please specify) OK Please enter any additional comments as to whether you feel there is a need for public transportation in Faulkton Area. Question Title * 13. Please enter any additional comments as to whether you feel there is a need for public transportation in Faulkton Area. OK DONE