MDX Roadside Travel Survey 2011

MDX/MDT US 1 / HEFT 2011 Roadside Travel Survey

* Survey Number

Location

The following are questions about the one-way trip you were making when you were given this survey.

1. What type of place did you BEGIN your ONE-WAY TRIP?

Home

Work Place

Non-Work Place

Non-Work Place (BEGIN)

Shopping/Dining	Hotel/Motel	Social/Recreational	Medical/Health Care/Dental Facility
School (K-12)	Airport	College/University/Vocational/Technical School	Preschool/Day Care
Other

What is the NAME of this PLACE, BUSINESS, OR BUILDING?

What is the ADDRESS of this place, business, or building?

Address 1 :

Address 2 :

City :

State :

Zip :

Cross Street 1

Cross Street 2

What TIME did you leave this place to START this ONE-WAY TRIP?

Month	Day	Year

2. What type of place did you END your ONE-WAY TRIP?

Home

Work Place

Non-Work Place

Non-Work Place (END)

Shopping/Dining	Hotel/Motel	Social/Recreational	Medical/Health Care/Dental Facility
School (K-12)	Airport	College/University/Vocational/Technical School	Preschool/Day Care
Other

What is the NAME of this PLACE, BUSINESS, OR BUILDING?

What is the ADDRESS of this place, business, or building?

Address 1 :

Address 2 :

City :

State :

Zip :

Cross Street 1

Cross Street 2

What TIME did you arrive at this place to END this ONE-WAY TRIP?

Month	Day	Year

3. Did you make any short INTERMEDIATE STOPS on this one-way trip?

Yes

No

3. Did you make any short INTERMEDIATE STOPS on this one-way trip?
Yes.

If yes, at what place did you stop (Select all that apply)?

4. Could you have used TRANSIT to make this one-way trip?

Yes

No

4. Could you have used TRANSIT to make this one-way trip?
Yes.

If yes, would you have taken?

Metrobus

Busway

Metrorail

Metrobus: Route #

Busway: Route #

5. How many PEOPLE were in your vehicle (including the driver and all passengers on the day you were given the survey?

6. How many DAYS A WEEK do you typically make this one-way trip? (Choose only one)

7. If you do not drive alone, do you typically travel with the SAME PEOPLE for this one-way trip?

Yes

No

Not Applicable

8. How LONG does it usually take you to make this one way trip?

Hours

Minutes

9. Did you make a RETURN TRIP on the survey day back to the place where you started your one-way trip?

No

Yes, I made a return trip

Yes, this was my return trip

PLEASE TELL US ABOUT YOURSELF

10. What is your home postal zip code?

11. Are you a:

Male

Female

12. What is your age group?

13. Are you disabled?

Yes

No

If you are disabled, what is your TYPE of disability?

Mobility or physical	Visual impairment	Hearing impairment
Other:

14. What is the HIGHEST level of education you COMPLETED?

Grade school	High school/GED	College-University - Undergraduate degree
Middle or Junior high school	Vocational/Technical school	College-University - Graduate degree
Some high school	Some college	Not applicable

15. Including yourself, how many PEOPLE in your home:

16. How many WORKING motor vehicles are at your home?

17. What is your current EMPLOYMENT status?

18. What was your household's approximate GROSS INCOME last year before taxes?

19. How many MONTHS will you live in South Florida this year?

Less than one month

One to six months

More than six months

20. Other comments or suggestions:

Contact Information to recieve free SunPass Mini

First Name :

Last Name :

Address 1 :

Address 2 :

City :

State :

Zip :

Phone :

Email Address :

Check here if you would like to be added to the Project Mailing list.

Yes

No