en Espaņol
Please provide the following contact information Fields in bold type are required
Name Email Employer Work Zip/Postal Code
1.When traveling, how are you currently travel to the places you want to go? (To select more than one option please hold down the ctrl key and click the option with your mouse.)
I drive I would use a BUS or public transportation Use a van pool or car pool or use community transportation I use a taxi I get a ride from my family, friends, or neighbors I walk I ride a bike
2. What type of public transportation do you presently use?(Select all that apply.)
I would walk or use a wheel chair to get to a bus stop and catch a local bus I would call to be picked up by a community bus or van at my house I would use a Park & Ride Other If "Other" is selected, please describe:
I would walk or use a wheel chair to get to a bus stop and catch a local bus I would call to be picked up by a community bus or van at my house I would use a Park & Ride Other
If "Other" is selected, please describe:
3. How far would you walk to get to a bus stop?(Select all that apply.)
One block Two Blocks Three Blocks Four Blocks or more
4. If you could choose the hours that you would like to have the bus available, which of the following would you choose?
Start Time End Time 6:30 AM 5:30 PM 7:00 AM 6:00 PM 7:30 AM 6:30 PM 8:00 AM 7:00 PM 8:30 AM 7:30 PM
5. Is a 30 minute period of time between buses convenient for you?
Yes No
6. Is a 30 minute period of time between buses convenient for you?
7. How often would you use public transportation (including Park and Ride)(Select all that apply)
Every Day Once or twice a week Once or twice a month Once or twice a year Rarely Never
8. Which of the following statements best describes you? (Select all that apply)
Student Employed Retired Unemployed Over 62 yrs of age Handicapped Own a truck or car
9. Do you feel your community needs public transportation?
10.If yes, please tell us for what purpose would you use public transportation? (To select more than one option please hold down the ctrl key and click the option with your mouse.)
Work School Medical Recreation Other If "Other" is selected, please describe:
11. Do you work or go to school in Clear Lake/Nasa area?
Yes Location No
