4. Do you require the assistance of a Personal Care Attendant (PCA) when you travel out- side your home?
5. Do you travel with a service animal (Guide Dog, etc.)?
Part 4. Functional Abilities
6. Do you currently use Palm Tran fixed-route bus service?
7. If you currently use Palm Tran fixed-route bus service, which routes do you use? __________________________________________________________________________
8. When was the last time you used the Palm Tran fixed-route bus service? __________________________________________________________________________
9. When are you UNABLE to use the Palm Tran fixed-route bus? (please indicate below the following situations that apply to you)
I can use Palm Tran regular bus service for some trips, but other times there are barriers that prevent me from using the bus.
I have difficulty understanding and/or remembering all of the things I would have to do to find my way to and from the bus.
I have difficulty getting to and from bus stops because I become disoriented easily.
I can only get to and from bus stops if the distance is not too great and there are curb cuts and sidewalks on the route.
I can only wait at Palm Tran bus stops if there is a bench or shelter.
The severity of my disability can change from day to day. I can ride the bus only when I am feeling good.
I cannot cross busy streets and intersections.
I have difficulty or cannot climb stairs and can only board a Palm Tran bus if it has a lift or ramp.
I have a health condition and cannot ride the bus if the walk is too far or if the weath- er is too hot.
I can never use the Palm Tran bus service by myself. 5