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* 1. Mark ALL of the transportation you or your family have used during the past 12 months to travel to work/appointments/shopping/social activities. (Check all that apply)

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* 2. If public transportation was easy to use and available to you and/or your family, which of the following would cause you to use the service? (Check all that apply)

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* 3. What changes could be made to your local transportation options to make them more appealing to you? (Check all that apply)

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* 4. Which of the following are your most commonly visited destinations or places you most often need to visit? (Check all that apply)

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* 5. When do you need transportation most often for each of the following general purposes (Select all that apply)

  Medical/Health Care Grocery Shopping/Meals/Nutrition Employment/School Recreational/Social Human/Social Services
9 PM - Midnight
6 PM - 9 PM
3 PM - 6 PM
12 PM - 3 PM
8 AM - 12 PM
6 AM - 8 AM
12 AM - 6 AM

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* 6. What City/Town, County, or Counties are the locations from QUESTION 5 located in?

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* 7. Do you or a family member need transportation outside of Ross County, but sometimes or never have it?

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* 8. How old are you?

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* 9. If English is not your first language, what is?

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* 10. What city/town do you live (or nearest city/town)?

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* 11. What county do you work in?

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* 12. How far away is your work location from your home?

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* 13. Which of the following BEST applies to you?

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* 14. Do you identify as any of the following? (Select all that apply)

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* 15. Are you or a family member currently using any transportation services that are available to you through the Medicaid program?

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* 16. What is your greatest transportation need?

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* 17. What improvements should be made to the current transportation options in Ross County?

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* 18. If you do not currently use public transit, why not?

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* 19. How often do you miss work because you are unable to get there?

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* 20. How often do you miss medical, counseling, or benefits appointments because you are unable to get there?

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* 21. I am aware of transportation services that are available in Ross County (check yes or no)

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* 22. If you would like to be contacted about transportation options in Ross County or would like to see the results of this survey, please leave a phone number or email address.

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