Membership Topics

Transportation Programs

Countywide Emergency Ride Home Application

Application Agreement and Baseline Survey

Your Name
Your Home Address
Home City
State
Zip Code
Home Phone
Your Email
Your Employer (Company)
Your Work Address
Work City
State
Zip
Work Phone

To qualify for the Countywide ERH Program you must travel to work at least one day a week by: bus, carpool, vanpool, bicycle, electric bicycle, or walking, and you must agree to complete one follow-up survey within a year.

This baseline survey is to help the Ecology Action establish commuter habits of Santa Cruz County residents. All information will remain anonymous.

I plan to use the following travel methods to get to work in the upcoming year (put estimated number of days per week):
Drive alone	days per week
Bus	days per week
Carpool	days per week
Vanpool	days per week
Bicycle	days per week
Walk	days per week
Telecommute	days per week
Other	days per week
Describe:

How many miles is it from your home to work? miles

How many days a week do you normally drive alone to work? days

What obstacles prevent you from using an alternative mode of transportation more often to commute to work?
What if a family member or I got sick, and I had to leave work?
What if a family member or I had an emergency, and I had to leave work?
What if I am asked by my supervisor to work late and I missed my ride?
What if my carpool driver had to leave early or stay late?
What if my bike or electric bike broke down or got stolen?
Please add any other reasons that prevent you from using an alternative mode of transportation more often for your daily work commute.:

Because of the Emergency Ride Home Program will you use an alternative mode of transportation more often to commute to work?		Yes

Have you previously registered with 511.org?	Yes OR No

Is your employer a member of Ecology Action’s Transportation Services?	Yes No Unsure

Please read the following carefully:

Participant Agreement:

I understand the guidelines of the Emergency Ride Home Program and qualify by traveling to work at least one day per week using an alternative mode of transportation.

I understand that the vouchers are non-transferable, and that the vouchers are to be used during work hours, and only on days when I have used an alternative mode of transportation for my commute. I agree to complete one follow up survey within a year of the date the voucher is issued to me, whether or not I use the voucher. Program is subject to end due to limited funds.

By clicking the "Send Now" button, I agree to comply with the conditions of this program and hereby release Ecology Action from any liability, claims, and demands for personal injury, loss, theft, or damage to my personal property; loss of income, consequential damage resulting from delays or absence of a taxi cab, or termination of the program.

Program Contact

Piet Canin

Vice President, Transportation Group
Phone: 831-515-1327
Email