General
Information
How would you rate
our service?
-- Select One --
Excellent
Good
Poor
How often do you use
the transit?
-- Select One --
Frequently
Seldom
Never
Type of service use
-- Select One --
Route
Demand
Responsive
How would you rate
the following?
Clean vehicle
-- Select One --
Excellent
Good
Poor
Bus pick up time
-- Select One --
Excellent
Good
Poor
Bus drop off time
-- Select One --
Excellent
Good
Poor
Driver courtesy
-- Select One --
Excellent
Good
Poor
Bus stops locations
convenient
-- Select One --
Excellent
Good
Poor
Trip lengths
acceptable
-- Select One --
Excellent
Good
Poor
Fares
-- Select One --
Excellent
Good
Poor
Dispatcher assistance
-- Select One --
Excellent
Good
Poor
What was the
purpose of the trip(s)?
Please check all that apply.
Work,
school
/education,
personal
business,
recreation,
shopping,
nutrition,
workshop,
medical/doctor
local,
medical/doctor
out of area
Your information
Do you have a
handicap?
-- Select One --
yes
no
Race:
-- Select One --
African American
Caucasian
Hispanic
Native American
Asian/Pacific Islander
Income:
-- Select One --
Under $5,000
$5,001 - $10,000
$10,001 - $25,000
$25,001 - $50,000
over $50,000
Sex:
-- Select One --
male
female
Age:
-- Select One --
6 or under
7 - 12
13 - 18
19 - 64
65 - 79
80 +
Comments:
Address
City/Zip
/
Phone
Email