Mercer County Coalition for Coordinated Transportation - Transportation Survey
We Need your Help
The Mercer County Coalition for Coordinated Transportation is working to develop a more responsive transportation system and we need your help. We are trying to identify transportation needs to pinpoint solutions to provide better services. As a community member, we value your input and would greatly appreciate your assistance.
To show our appreciation, those who participate will be entered into (4) drawings - each winner will receive a $50 Visa gift card!
Please complete the survey and return it where you receive it or fold, tape and mail it to the return address. Thank you so much for all your help!
~ Sincerely,
The Mercer County Coalition for
Coordinated Transportation ~
Questions?
Contact The Arc Mercer at (609) 406-0181, ext. 127
What is your address?

Street

Town

Zip Code
Into which age group do you fit?
17 and younger
18-64
65 and older
 
Do you use any of the following for travel? (check all that apply)
Walker/Cane
Crutches
Personal Care Attendant

Other
White Cane
Wheelchair/Scooter
Service Animal
Would you describe your income as?
Less than $11,000
Over $40,000
$11K-20K
$21K-$40K
 
If you are unemployed, is transportation a barrier to obtaining employment?
Yes
No
N/A
 
If you are employed, is getting transportation to or from your job a challenge
Yes
No
N/A
 
What, if any, would be your limitations to taking public transportation?
Cost
Knowledge of how to use Public Transportation System
Accessibility of Bus Stops
Stations Accessibility of Bus or Train
Which options do you currently use to travel? (check all that apply)
Access Link
Arc Mercer
Bike/Walk
CrossTown
Family/Friends
Hopewell Valley Rides

Other
Logisticare/Medicaid
Municipal
NJ Transit Bus
NJ Transit Train/RiverLine
Personal Automobile
Private
RideProvide
Taxi
TRADE
Please check all of the obstacles that currently prevent you from getting where you need to go
  No ride or bus to that location
  No ride available when I need it
  No accessible vehicle
  Too expensive
  Can drive but dont have a car
  Transportation Provider requires too much advanced notice for request
  Transportaion may be available but I dont know how to use it
  Cant get ride based on trip purpose
  Need personal aide or driver assistance
  Bus Stop not accessible
Please list all the destinations you regularly travel to, or would like to travel to, using a non-personal vehicle.

Bank


Doctor's Office


Doctor's Office #2


Employment


Grocery


Personal Shopping


Post Office

Pharmacy


Recreational Activity


Recreational Activity #2


Other


Other #2


Other #3

Please indicate where you are currently traveling to and places you would like to travel to but cannot due to obstacles you are experiencing.

Destination



Frequency

Transportation Provider



Time From

Obstacle



Time To
 
Day(s) of the Week
Sunday
Monday
Tuesday

Wednesday
Thursday
Friday

Saturday
Flexible
Trip #2

Destination



Frequency

Transportation Provider



Time From

Obstacle



Time To
 
Day(s) of the Week
Sunday
Monday
Tuesday

Wednesday
Thursday
Friday

Saturday
Flexible
Trip #3

Destination



Frequency

Transportation Provider



Time From

Obstacle



Time To
 
Day(s) of the Week
Sunday
Monday
Tuesday

Wednesday
Thursday
Friday

Saturday
Flexible
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