Exit Drivers Ages 15 -35 Question Title * 1. Please Enter your Zip Code: ZIP/Postal Code Question Title * 2. Have you personally known someone who has been killed in a vehicle crash? Yes No If yes, what is your relationship to that individual(s)? Question Title * 3. Do you have a Driver's License? Yes No Question Title * 4. Are you the owner of the vehicle you drive? Yes No Question Title * 5. How many traffic tickets (moving violation) have you received? 0 1-2 3 or more How long after licensure did these occur? Please list Years and Months: Question Title * 6. Please list reason(s) for citation(s) N/A if 0: Citation #1: Citation #2: Citation #3: Question Title * 7. As a driver, how many incidents/crashes have you been involved in? 0 1-2 3 or more If (1) or more crashes have occurred, how long after licensure did they occur? Please list Years and Months: Question Title * 8. Please describe briefly what you could have done differently to have avoided/prevented them.*N/A if 0 crashes have occurred Question Title * 9. What percentage of the time do you wear your seatbelt? 0 100 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 10. Why do you wear/not wear a seatbelt? Question Title * 11. Have you ever completed a State Driver’s Ed program? Yes No If Yes, did you find the program to be beneficial, neutral, a waste of time, or other? Question Title * 12. Who or what had the greatest influence over your driver development? Driver's Ed program/instructors Parents Relatives or other A specific life experience None of the above Question Title * 13. Do you drive more cautious with passengers in the car? Yes No Question Title * 14. For the most part, How would you describe driving? Enjoyable Neutral A waste of time Other Why? Question Title * 15. Would you be willing to engage in taking additional surveys or other forms of additional communication for our research? Yes No Question Title * 16. If yes, please provide your name and specify which method of communication you prefer: First Name: Email: Phone: If Phone, what is the best time to call? Done
