Application | E-Bikes for All

Are you a resident of any of the following: *

If "Other", please specify: *

Are you interested in using an electric bike for transportation? *

Yes
No
Maybe

If "No", why not?

If "Maybe", what questions or concerns do you have?

What would you use an e-bike for most often? *

Commuting
Errands
Job search or training
Recreation

What is your primary mode of transportation now? *

If "Other", please specify:

Do you currently have a "smartphone"? (A mobile phone with internet access and the ability to download apps) *

Yes
No

What type of smartphone do you have? *

Apple
Android
Other / Unknown

If "Other", please specify:

Does your phone have Bluetooth? *

Yes
No
I do not know

Name *

First

Last

Email *

Phone Number

Address *

Address Line 1

Address Line 2

City

State

Zip Code

We 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).

Age

Gender (to which do you most identify?)

Male
Female
Non-Binary
Other

If "Other", please specify (optional):

Which of the following best describes you?

If not listed, please specify (optional):

Annual Household Income *

What is your current employment status?

Highest level of education reached

Primary Language

If "Other", please specify:

Do you own your home or rent? (consider the home owned even if there is a mortgage loan)

Owned by you
Owned by someone else in your household
Rented
Occupied without payment of rent

Which best describes your home?

If "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 vehicle
I have regular access to a vehicle owned by someone else
No

If "Yes", do you have off-street parking available for that vehicle?

Yes
No
Sometimes

Approximately how much money do you spend on transportation each month? (car payments, car insurance, fuel, MBTA passes, ride share/taxi fares, etc.)

Want 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.

E-Bikes for All Application