E-Bikes for All Application Please enable JavaScript in your browser to complete this form.Are you a resident of any of the following: *Select oneHarbor Point ApartmentsCity of MaldenBoston Housing AuthorityMedford Housing AuthorityBowdoin ApartmentsCity of LawrenceOtherIf "Other", please specify: *Are you interested in using an electric bike for transportation? *YesNoMaybeIf "No", why not?If "Maybe", what questions or concerns do you have?What would you use an e-bike for most often? *CommutingErrandsJob search or trainingRecreationWhat is your primary mode of transportation now? *Public TransportationCar (travel alone)Ride Share (ex. Uber, Lyft)TaxiCarpool or rides from othersWalkBicycle (non-electric)Scooter or MopedElectric BikeOtherIf "Other", please specify:Do you currently have a "smartphone"? (A mobile phone with internet access and the ability to download apps) *YesNoWhat type of smartphone do you have? *AppleAndroidOther / UnknownIf "Other", please specify:Does your phone have Bluetooth? *YesNoI do not knowName *FirstLastEmail *Phone NumberAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWe would like to collect the following demographic information from all applicants. Information regarding age, gender, race/ethnicity and education will not be used in the selection process. This information will be anonymized in order to create an overview of the applicant group for research purposes.   This information will be kept CONFIDENTIAL and stored securely by Metro Mobility. If you have any questions about the handling of this data, please contact Metro Mobility at info@metromobility.io. If a summary of this demographic information is reported to the state of Massachusetts, it will be anonymized (not tied to your name or identifying information).AgeGender (to which do you most identify?)MaleFemaleNon-BinaryOtherIf "Other", please specify (optional):Which of the following best describes you?Asian or Pacific IslanderBlack or African AmericanHispanic or LatinoNative American or Alaskan NativeWhite or CaucasianMultiracial or BiracialA race/ethnicity not listed hereIf not listed, please specify (optional):Annual Household Income *Less than $15,000$15,000 - $24,999$25,000 - $34,999$35,000 - $49,999$50,000 - $74,999$75,000 - $99,999$100,000 - $149,999$150,000 and aboveWhat is your current employment status?Employed full-time (40+ hours / week)Employed part-time (less than 40 hours / week)Unemployed (currently looking for work)Unemployed (NOT currently looking for work)StudentRetiredSelf employedHighest level of education reachedNo schooling completedNursery school to 8th gradeSome high school, no diplomaHigh school graduate, diploma or equivalentSome collegeAssociate's degree (for example: AA, AS)Bachelor's degree (for example: BA. BS)Master's degree (for example: MA, MS, MEng, MEd, MSW, MBA)Professional Degree (for example: MD, DDS, DVM, LLB, JD)Doctorate Degree (for example, PhD, EdD)Primary LanguageEnglishSpanishPortugueseChinese (incl. Cantonese and Mandarin)FrenchFrench CreoleItalianRussianVietnameseGreekArabicCambodian (including Mon-Khmer)OtherIf "Other", please specify:Do you own your home or rent? (consider the home owned even if there is a mortgage loan)Owned by youOwned by someone else in your householdRentedOccupied without payment of rentWhich best describes your home?Single family houseMulti-family houseApartmentCondoCo-op housingTownhouseMobile homeOtherIf "Other", please specify:Do you own a car or truck, or have use of one that is owned by someone else?Yes, I own the vehicleI have regular access to a vehicle owned by someone elseNoIf "Yes", do you have off-street parking available for that vehicle?YesNoSometimesApproximately how much money do you spend on transportation each month? (car payments, car insurance, fuel, MBTA passes, ride share/taxi fares, etc.)Less than $25$25 - $49$50 - $99$100 - $149$150 - $249$250 - $349$350 - $499$500 or aboveWant to tell us anything else? Add it here:By clicking "Submit", you hereby certify that all the information provided above is complete, true, and correct to the best of your knowledge and belief.Submit