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13. Using a mobility aid (wheelchair, etc.) or on your own, how far can you walk or

travel? Less than one block

3 blocks (1/4 mile) 6 blocks (1/2 mile)

9 blocks (3/4 mile) More than 9 blocks

14. Does the weather affect your ability to travel outside and use the Palm Tran fixed-

route bus? Yes

No

If yes, please explain:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

15. Can you wait up to 30 minutes for the Palm Tran fixed-route bus at a bus stop?

Yes Yes, only if the stop has a bench and shelter Yes, but I don’t like to wait that long N o , p l e a s e e x p l a i n : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

16. How would you describe the terrain where you live?

Flat

Sidewalks

Uneven sidewalks

Steps

No sidewalks

Part 5. Current Travel Information

17. Please list trips that you will make most frequently using the van/shared-ride service.

SAMPLE

From:

(1)

35 Palm Drive

To: Place and address Publix, 150 Main

From:

  • (1)

    ________________________________

  • (2)

    ________________________________

To: Place and address

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

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