Transportation Survey

The purpose of this survey is to improve transportation. Please do not provide any personal information that might identify you. Thank you!

Please complete this survey and drop in the box provided or you may complete it online at

* 1. Where are you completing this survey? (Please provide the name of the county):

* 2. Do you need transportation on a regular basis for any of the following? Check all that apply.

* 3. How do you usually get places?

* 4. Are you currently employed?

* 5. Do you have a disability that requires you to use a mobility assistance device such as a cane, walker, or wheelchair?

* 6. Is your transportation to work limited because of where you live?

* 7. Which town do you live in (or nearest to)?

* 8. Which town do you work in (or nearest to) if applicable?

* 9. What town is your childcare provider in if you have one?

* 10. What town is your primary medical provider in (if any)?