Solano Mobility Study

P 106 p Solano Transportation Authority Appendices Appendix D 2017/18 Survey of Transportation Needs of Solano County Seniors and People with Disabilities The Solano Transportation Authority is gathering information from seniors and people with disabilities on their transportation needs. The information will be used to identify strategies to improve the overall mobility for these most vulnerable citizens. The survey can be completed online at www.solanomobility.org , or by mailing this completed survey by August 31, 2018. For more information about the survey, contact Debbie McQuilkin at 707-424-6075 or dmcquilkin@sta.ca.gov. If you need help completing the survey contact the Solano Mobility Call Center at 800-535-6883, Monday- Friday 7am-5pm. 1. CONTACT INFORMATION: Your contact information is not required, but may be helpful if more information is needed to understand your transportation needs. Any information provided will be kept confidential. Name: ____________________________________ Phone: _______________________ Email: ______________________________________________________________________ Your answers to the questions below will help us understand your transportation needs as well as provide us with information needed to apply for State and Federal transportation grants. 2. What community do you live in?  Benicia  Rio Vista  Vacaville  Dixon  Suisun City  Vallejo  Fairfield  Travis AFB  Unincorporated Solano County 3. Do you have any limitations on your ability to drive? Mark all that apply.  No restrictions  No longer drive  Restricted to local driving  Never drove  Restricted to daylight hours  Require adaptive equipment  Other __________________________________________________________________________ 4. What is your primary means of travel to appointments, work and/or errands?  Personal vehicle  Taxi  Private service/paid caregiver  Friends/relatives  Bus  Volunteer driver  Walking/biking  Paratransit  Other_____________________ 5. Which of the following have you used in the past year? Mark all that apply.  Personal vehicle  Taxi  Private service/paid caregiver  Friends/relatives  Bus  Volunteer driver  Walking/biking  Paratransit  Other______________________ 6. Is your primary means of travel meeting your transportation needs?  All the time  Some of the time  Most of the time  Not at all, please explain:________________________________________ 7. How important are mobility services to you?  Not Important (I do not need mobility services)  Important (but I have other transportation options)  Extremely Important (needed for food and medical appointments)  Potentially Life Threatening (needed for medical treatment, etc.) 8. Please share any transportation challenges you have or ideas to improve your transportation mobility. 9. What destinations do you need to get to that you can’t get to with your current means of travel? 10.Are you interested in learning to ride transit through Travel Training?  Yes  No If YES, please provide your contact information. Name: __________________________________ Phone Number: ____________________________ 11.Do you have a smartphone?  Yes  No 12.Do you know how to use apps?  Yes  No Are you aware of the following Solano Mobility Programs? Check as many as apply. Program Not aware Aware I use Program Not aware Aware I use Solano Mobility Call Center    Faith in Action Volunteer Driver Program    Countywide In-Person ADA Eligibility Program    Fairfield Senior Driver Program    Travel Training    Senior Safe Driver Information    Solano County Intercity Taxi Scrip Program    Regional Transit Discount Card    Local Taxi Scrip Program    Senior Clipper Card    American Cancer Society Transportation Services    Veteran’s Affairs Medical Shuttle    Gender:  Female  Male House- hold size:  1  2  3 or more Income:  Under $15,000  $15,000 - $24,999  $25,000 - $39,999  Over $40,000 Age:  Under 16  16 to 21  22 to 54  55 to 74  75 or older Where do you live?  With my parents  My own residence  Relative’s residence  Residential community  Medical facility  _________________ Who helps you with your transportation needs?  Nobody, I live alone  Nobody, I’m the caregiver  Nobody, I drive  Spouse  Relative  Caregiver  Roommate  __________________ RegionalTransitDiscountCard SeniorSafeDriving Info TaxiScripPrograms TransitTripPlanning TransportationSchedules TravelTraining Vanpool andCarpoolPrograms VolunteerDriverProgram ADAEligibilityProgram ADAPrivateTransportation BikeMaps ClipperCardSales CommuterBike Incentives CommuterEmergency RideHomeProgram Commuter Incentives EmployerOutreachProgram Are you interested in Travel Training? FREE one-on-one training that will help you to gain the skills to ride public transit in an independentmanner. Contact the Solano Mobility Call Center at 800-535-6883 (Monday-Friday 7am – 5pm) www.solanomobility.org Fold and seal with tape. DO NOT STAPLE. The Solano Mobility Call Center provides information about Transportation Options: Complete This Survey & Mail Back by August 31, 2018. 13. 14. 15. 16. 17. 18. 19. 20.