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Alameda County has a Safe Routes to School (SR2S) program to reduce traffic congestion (and related air pollution) from school travel, and to improve children’s health through exercise. Please help us evaluate and improve the program by taking 10 minutes to complete this survey. Please only fill out one survey per family. All responses will be kept confidential. Thank you for response.

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* 1. What is the street intersection nearest your house? (optional)

Please tell us about your child(ren) and the schools(s) they attend. If more than 3 children, please list the youngest of school age.

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* 2. Gender

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* 3. Please type in the name of your child's school.

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* 4. Grade

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* 5. Does this school have a Safe Routes to Schools Program?

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* 6. What is the approximate distance from your home to the school?

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* 7. Has this child asked your permission to walk or bike to/from school in the last year?

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* 8. Last week, how did this child travel TO school? Please check one box per day.

  Walk Bicycle Family Car (your kids only) School bus Carpool (with other kids) City bus/transit Other (scooter, skateboard, etc.)
Monday
Tuesday
Wednesday
Thursday
Friday

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* 9. Last week, how did this child travel FROM school? Please check one box per day.

  Walk Bicycle Family Car (your kids only) School bus Carpool (with other kids) City bus/transit Other (scooter, skateboard, etc.)
Monday
Tuesday
Wednesday
Thursday
Friday

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* 10. In general, was this a typical week of travel for this child?

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* 11. Do you have a second child who attends elementary, middle, or high school in Alameda County?

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