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   <br />  <br /> <br />4. Are there sidewalks at your residence? ____YES ____ NO <br /> <br /> <br />5. What is the most difficult part of riding the bus for you? <br /> <br />_________________________________________________________________________ <br /> <br />6. What is the closest bus stop to your home? (Please give location)? <br /> <br />_________________________________________________________________________ <br /> <br />In the next section, please check “Yes,” “No,” or “Sometimes.” If you answer “No” or <br />“Sometimes” to any of these questions, explain your answer in the space below the <br />question. <br /> <br />7. Can you get to this bus stop by yourself? <br /> <br />_____YES _____NO _____SOMETIMES <br /> <br />_________________________________________________________________________ <br /> <br />8. Can you board the bus by yourself? <br /> <br />_____YES _____NO _____SOMETIMES <br /> <br />_________________________________________________________________________ <br /> <br />9. If vision-impaired, are you able to travel a distance of 200 feet without assistance? <br /> <br />_____YES _____NO _____SOMETIMES <br /> <br />_________________________________________________________________________ <br /> <br />10. Are you able to travel a distance of 3 blocks (1/4-mile) without assistance over different <br />types of terrain? <br /> <br />_____YES _____NO _____SOMETIMES <br /> <br />_________________________________________________________________________ <br /> <br />11. Able to climb three 12-inch steps without assistance? <br /> <br />_____YES _____NO _____SOMETIMES <br /> <br />_________________________________________________________________________ <br />25