Transportation Survey

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Pike County Community Based Transportation Survey

The purpose of this survey is to improve transportation services, especially for getting people to and from work, appointments or shopping. All survey information is confidential.

* Indicates required field

1. Gender *

Male Female Other

2. What is your age? *

Less than 13 0-18 19-25 26-35 36-45 46-55 56-59 60-74 75+

3. Do you have a reliable source of transportation? *

Yes No

If no, to the previous answer, how do you get to your destination? *

Walk Ride a bicycle Call public transportation Drive own car Borrow a car Call a friend Call a family member Call a social service provider Other

Check all that apply.

If other, please list: *

4. Places you need to go. Check all that apply. *

Doctor Grocery Court Work Visit friends and family Shopping PCDJFS Drugstore Chilld Care Other

If other, please list: *

5. On what day(s) of the week is it hardest for you to get to work, appointments or other places you need to go? Check all that apply. *

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

6. During what time(s) of the day is it hardest for you to get to and from work, appointments or other places you need to be? Check all that apply. *

Early Morning 5:00 A.M. - 8:30 A.M. Late Morning 8:30 A.M. - Noon Early Afternoon Noon - 3:00 P.M. Late Afternoon 3:00 P.M. - 6:00 P.M. Evening 6:00 P.M. - 9:00 P.M. Late Night 9:00 P.M. and later

7. Are you aware Pike County has a public transportation system? *

Yes No

Are you aware Pike County has more than one transportation option? *

Yes No

8. Do you use public transportation? *

Yes No

If no, why not? *

9. Do you have a disability? *

Yes No

If yes, check all those that apply: *

Developmental/Learning Psychiatric Vision Hearing Other

If other, please list: *

10. Are you eligible to receive SSI, Social Security Disability, TANF or other benefits with income guidelines? *

Yes No

11. How much are you willing to pay for a one-way ride to or from work, appointments or other places you need go? (Mark the maximum amount you would be willing to pay.) *

$1.00 $1.50 $2.00 $2.50 $3.00 More than $3.00

12. Please list any suggestions to improve transportation services in Pike County: *

Submit

A division of Community Action Committee of Pike County.