Transportation Provider Survey

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2023 HSTP Urbanized Area Transportation Provider Survey

Please complete the attached survey (or the online version at forms.gle/K6TUA823otKC2M1c7) as thoroughly as possible. Write “N/A” after any question that does not apply to your services or clients. If you have any questions, please contact Mimi Hutchinson at (217) 531-8285 or ehutchinson@ccrpc.org. Organization and Services Provided The following section will ask about the general characteristics of your organization and the nature of the services it provides. 1. Contact Information Name: __________________________ Address: Telephone: Email address: Name of survey responder: Title of survey responder: _ Agency website: _ Comments: 2. Please check the box that best describes your organization: Adult day care Faith-based organization Shelter Public transit agency Hospital Private transportation service (other than taxi) Medical center Ambulance Nursing home Private school Head Start YMCA/YWCA Nutrition center Neighborhood center Taxi Social service agency (non-profit) Social service agency (public) Senior center Other: 3. What are the major services provided by your organization? (Circle all that apply) Transportation Residential facilities Healthcare Income assistance Social services Screening Nutrition Information/referral Counseling Recreation Day treatment Homemaking/chores Job training Employment Diagnosis/evaluation Rehabilitation Job placement Other:


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Transportation Provider Survey by Mimi Hutchinson - Issuu