Survey/Feedback Form

Please Take two minutes to complete our on-line survey. All information is kept strictly confidential and used only to measure the success of this program.

Your Information

First Name*

Last Name*

Age

Under 20 21-30 31-40 41-50 51-60 60+

Gender

Female Male

Street Address*

City*

Province

AB - Alberta BC - British Columbia MB - Manitoba NB - New Brunswick NL - Newfoundland and Labrador NS - Nova Scotia NT - Northwest Territories NU - Nunavut ON - Ontario PE - Prince Edward Island QC - Quebec SK - Saskatchewan YT - Yukon

Postal Code

Phone*

Email*

Must be an valid email address

Your Carpooling Information

Destination/Work-Site (ie: Name of Employer):

Average Daily Commute Distance (To and From in KM):

Average Daily Commute Time (in minutes):

Usual/previous method of commuting:

Drive Alone Transit Walk Cycle Other, specify:

Type of Car Driven:

None Small Car Compact Car Mid-Sized Car Full-Sized Car Van Truck/SUV

Were you successful in making carpool arrangements? (Y/N):

Yes
No

If yes, please provide average number of persons in your carpool (including yourself).

On average, how many days each week do you carpool?:

1 2 3 4 5

Who do you carpool with most?:

Family/household member Co-Worker Neighbour Other

How long have you been carpooling for? :

Weeks Months Years

Please indicate which of the following most describes your carpool habits? (Check one)

I was unable to find anyone to carpool with
I carpooled less than 5 times
I carpooled between 6 and 20 times
I continue to carpool regularly

Which statement below describes the strongest motivation you have for wanting to carpool?

I want to save money.
I'm concerned about the environment.
I don't have anywhere to park.
I don't like driving during peak hours.
I don't have a car.

Other Information

Please rate the following aspect of the https://www.carpool.ca program (from 1 to 5 with 1 being the lowest and 5 being the highest).

User-Friendliness

1 2 3 4 5

Web Design

1 2 3 4 5

Sufficient Relevant Information

1 2 3 4 5

Easy to Find

1 2 3 4 5

How did you hear about this program?

Employer/Post-Secondary Institution Referral

Media

Internet Search Engines

Word of Mouth

Promotional Materials (posters etc)

Road Sign

Information Session/Transportation Fair

Parkade Promotion/Referral

Other

Social Media (Facebook, Twitter, etc)

Any other comments you would like to add: