Shipley Reimagined - CityConnect Baseline Monitoring
Event Attended (if applicable)
Date of Birth
Q1. Employment Status
If "Other" please specify
Not currently working
Full time education/training
Part time education/training
Q2. Place of employment/education/training?
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
Q4. Why do you ride? (check all that apply)
To get from A to B
Q5. How often do you ride?
What would encourage you to ride more? (check all that apply)
Having more time
Safer cycling routes
Better facilities at work
Better awareness from drivers
The information which you provide will only be used in the manner described in the attached privacy notice (
). 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
* 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:
Tel: 0113 2517366.
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