Qualtrics Survey | Qualtrics Experience Management

Agency Name:

Address (Street, City, State, Zip Code):

County:

CTD:

Phone Number:

Fax Number:

Service Type (Check all that apply):

Demand-Response
Deviated Fixed Route
Fixed Route
Other (please specify)

Do you have a website? If so, please share the link:

Contact Name:

Contact Email:

Contact Phone Number:

Agency Service Hours (select all that apply):

Weekdays
Saturday
Sunday
Other (please specify)

Agency Funding Type (select all that apply):

Section 5310 Capital
Section 5310 State Operating
Section 5311 Capital
Section 5311 State Operating
Section 5307 Capital
Section 5307 Operating
Other (please specify)

Base Fares (Youth, Seniors, one-way, etc.):

Total Number of Vehicles:

Total Number of Lift Vehicles:

On-Board Communication:

Yes
No

Do you have any social media (please provide links):

Facebook
X (Formerly Twitter)
Instagram
LinkedIn
Other (please specify)

Please list any other additional members (names and emails) of your team who would like to receive RTAP newsletters, training information, and resources:

Any other information related to your agency that you would like Kansas RTAP to publish on our website: