SAFE ROUTES TO SCHOOL TRAVEL SURVEY 

Dear Teacher,
This survey will be used to help identify future candidates for this program.
Please take a few minutes today to ask your homeroom students the following 
questions and record the appropriate responses. Please send the results back to 
Johanna Garcia Ð Transportation Department Ð Norwalk Public Schools when completed. 

Thank you, 

DEPARTMENT OF PUBLIC WORKS

Teacher Name ______________________________ 		Grade ___________________________ 
Number of Students __________________________ 		Survey Date   _____________________

1.	How may students walked to school today? 	
2.	How many students rode a bicycle to school today? 	
3.	How many students came in a car to school today? 	
4.	How many came on a school bus today? 	


Please return the completed survey to the transportation office today. This information will
help us determine how the students are currently getting to school in the morning to enable
us to plan for safer routes. 

Thank you for your help!