Public Transportation Needs Survey
Sullivan County Community Mobility Project
Public Transportation Needs Survey
Charlestown Residents
Do you live in Charlestown? _____ Yes _____ No
- If you answered “Yes” what area of Charlestown do you live in? __________________
If you are not a Charlestown resident, where do you live? ________________________________________________________________________
Where do you work?
___ Charlestown --------___ Claremont ___ Springfield VT ___ Keene
___Lebanon/Hanover Other (Please Specify) _______ ______
Are you familiar with the Dial-A-Ride service currently offered in Charlestown by Community Alliance Transportation Services? ___Yes ___ No
Have you ever used the Dial-A-Ride service offered by Community Alliance
Transportation Services? ___ Yes ___ No
Are you familiar with the Red Cross Volunteer Driver service? ___ Yes ___ No
Have you ever used the Red Cross Volunteer Driver service? ___ Yes ___ No
Are you familiar with the Ride Share Program? ___ Yes ___ No
Have you ever used Ride Share? ____ Yes _____ No
Would you be comfortable using public transportation if it was available?
_____ Yes _____ No
If you answered “Yes” to the above question please skip the next two questions.
If you answered “No” to the above question could you tell us why you would not use public transportation? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Would you be interested in having someone discuss the service and how you could access it? _____ Yes _____ No
Do you use your car for work? _____ Yes _____ No
Do you drop off or pick up children on your way to or from work? ___Yes ___ No
Would you use public transportation services to get to work, if it was available?
_____ Yes _____ No
What time do you need to arrive at work? _____
What time do you leave work? _____
(Continued on other side)
Where do you shop and/or conduct personal business?
____ Charlestown ____Claremont ___ Springfield VT ____ Keene
___ Hanover / Lebanon Other (Please Specify)
Do you use your car for personal business or errands during the day? ___ Yes ___ No
Would you use public transportation services to get to shop and/or conduct personal business, if it was available? ---_____ Yes _____ No
Where do you access medical services?
_____ Charlestown --------_____ Claremont _____ Springfield VT _____ Keene
_____ Hanover / Lebanon Other (Please Specify)
Would you use public transportation services to get to your medical appointments, if they were available? _____ Yes _____ No
Would you be willing to pay for public transportation services? ___Yes ___ No
If you answered “Yes” to the above, how much would you be willing to pay? _______________________________________________________________________
Do you need transportation services evenings or week ends? ___ Yes ___ No
If you answered “Yes” to the above, can you specify what evening hours and/or week end days would best meet your transportation needs? ____________________________________
Do you have any special needs regarding transportation (i.e. wheelchair, walker, visual impairment, etc.)? ___ Yes ___ No
If you answered “Yes” to the above, would you tell us what are they? _______________________________________________________________________
If there were regular public transportation services available in Charlestown, where should bus stops be located to best serve the Community? _____________________________________________________________________________
Are there other transportation services that you would like to have provided by the public transportation provider? _____ Yes _____ No
If you answered yes, would you tell us what they are?
__________________________
Signature (Optional) Date
______________________________
Address (Optional)
Please accept our sincere thanks for completing this survey
(4/08)
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