Mobility and Accessibility Transportation Survey

Help us identify the needs and gaps in transportation services for Older Adults and Individuals with disabilities, including their families and caregivers.
1.Are you currently able to drive?(Required.)
2.If you are able to drive, to which of the following local destinations do you drive? (Check all the apply)(Required.)
3.If you are able to drive yourself, what challenges have you experienced during the past 3 months? (Check all that apply)(Required.)
4.During the past 3 months, were you unable to travel to any of the following destinations because you did not have access to transportation (either your own vehicle or a ride)? (Check all that apply)(Required.)
5.During the past 3 months, how often are you unable to get where you need to go because of not having a way to get there?(Required.)
6.What type of transportation have you used in the past 3 months? (Check all that apply)(Required.)
7.Do you know what the CAPCO’s Volunteer Driver Program is?(Required.)
8.During the past 3 months, what barriers to reliable transportation do you experience? (Check all that apply)(Required.)
9.If you experience transportation barriers, how do these affect you? (Check all that apply)(Required.)
10.Have you had difficulty finding a ride to a medical appointment in the past 3 months? If yes, please select all reasons that apply:(Required.)
11.How many times in the last 3 months have you had to cancel a medical appointment due to lack of transportation?(Required.)
12.What prevents you from using public transportation in your area? (Check all that apply)(Required.)
13.If you depend on others for any of your trips, who do you depend on? (Check all that apply)(Required.)
14.Over the past 3 months, how much did you rely on others for transportation?(Required.)
15.Who lives with you? (Check all that apply)(Required.)
16.Do you identify as a person with a disability or other physical or cognitive/intellectual limitation?(Required.)
17.Does anyone who lives with you identify as a person with a disability or other physical or cognitive/intellectual limitation that affects their ability to drive?(Required.)
18.How many motor vehicles (cars, vans, trucks, motorcycles) are available in your household?(Required.)
19.What is your gender?(Required.)
20.What is your age?(Required.)
21.What is your annual total household income?(Required.)
22.What zip code do you live in?(Required.)
23.Please use this space for comments or service suggestions: