Shipley Reimagined - CityConnect Baseline Monitoring
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Email address
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Your email
Name
*
Your answer
Event Attended (if applicable)
Your answer
Date Attended
MM
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DD
/
YYYY
Home Postcode
*
Your answer
Date of Birth
*
MM
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DD
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YYYY
Q1. Employment Status
If "Other" please specify
Full time
Part time
Job seeker
Apprentice
Not currently working
Full time education/training
Part time education/training
Other:
Clear selection
Q2. Place of employment/education/training?
Your answer
Q3. Do you have access to a working bike?
I have my own bike
I share with my family or friend
I sometimes hire a bike
No
Clear selection
Q4. Why do you ride? (check all that apply)
To get from A to B
Leisure
Fitness
Social
Q5. How often do you ride?
Daily
Weekly
Monthly
Less Often
Never
Clear selection
What would encourage you to ride more? (check all that apply)
Better bike
Better equipment
Having more time
Confidence
Safer cycling routes
Better facilities at work
Better awareness from drivers
CONSENT
The information which you provide will only be used in the manner described in the attached privacy notice (
https://goo.gl/C3mZMw
). If you agree to allow the West Yorkshire Combined Authority (WYCA) to use your information as specified, please provide your consent by ticking the appropriate boxes below.
I consent to WYCA using my personal data above, for the purpose of monitoring and evaluating the impact of the Confident Commuter Package project managed by Bradford Capital of Cycling I understand that this may involve WYCA or someone nominated by it contacting me [by email] at a further date with a follow-up survey to assess the impact of the programme.
*
Please tick here if you consent to us using your data for the monitoring and evaluation purposes specified
Please tick here if you consent to other follow-up contact
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* You can withdraw your participation at any time by contacting us at the following address: CityConnect Team, Wellington House, 40-50 Wellington Street, Leeds, LS1 2DE E-Mail:
cityconnect@westyorks-ca.gov.uk
Tel: 0113 2517366.
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