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Submit Ticket: Assistance Request

Gender
Male
Female
Prefer not to share
Do you know how to ride a bike?
Yes
Yes, but it has been a while.
No
Race:
Housing/Living Situation
Own Home
Rent Home/Apartment
Transitional Housing
Homeless
Other
Sources of Income
Are you currently a student?
Yes
No
Taking time off
Select all that apply to you.
Your Current Method of Transportation
What destinations do you most find difficult to travel to?
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