• Required

First Name

1. What County do you live in? *

2. What is your home zip-code? *

3. What is the primary language spoken at home?
English
Spanish
Creole
Other

4. How do you identify yourself?
White-non-hispanic
Black-non-hispanic
Hispanic
Native American
Asian
Other

5. Do you have a child/children in elementary or middle school? If not, please proceed to question 15. *
Yes
No

6. If so, what is the name of your child's school?

7. What grade(s) is/are your child(ren) in (K-8)?
K
1
2
3
4
5
6
7
8

8. How far do you live away from school?
Less than 1/4 mile (approx. 3 blocks)
1/4 mile up to 1/2 mile (approx. 3-6 blocks)
1/2 mile up to 1 mile (approx. 6-10 blocks)
1 mile up to 2 miles (approx. 10-20 blocks)
More than 2 miles (approx. more than 20 blocks)
Don't know

9. On most days, how does your child arrive at school?
Walk
School Bus
Carpool
Other (skateboard/scooter/inline skates etc.)
Bike
Family Vehicle
Transit

10. On most days, how does your child leave for home after school?
Walk
School Bus
Carpool
Other (skateboard/scooter/inline skates etc.)
Bike
Family Vehicle
Transit

11. On most days, how long does it take your child to get to school?
Less than 5 minutes
5 to 10 minutes
11 to 20 minutes
More than 20 minutes
Don't know / Not sure

12. On most days, how long does it take your child to get home from school?
Less than 5 minutes
5 to 10 minutes
11 to 20 minutes
More than 20 minutes
Don't know / Not sure

13. Do you feel that your youngest child is old enough to walk to school alone?
Yes
No

14. At what age would you allow your child to walk to school alone?
5 years old or younger
6-9 years old
10-12 years old
13+ years old
I would never grant permission

15. Would you participate or encourage a child to participate in a program that would encourage walking to and from school with adult supervision? *
Yes
No

16. If not, please provide a comment or suggestion.

17. Is there enough police and crossing guard presence in route to your local elementary school? *
Yes
No

18. If not, please provide a comment or suggestion.

19. Can you identify any problematic areas/locations that would prevent you from allowing a child to walk to school?

Enter Word Verification in box below *

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