STP Exchange Membership Application

The STP Exchange is a resource for peer-to-peer communication, information exchange, and networking among members. Members have the opportunity to tap into web-based information, to exchange information with other members, to receive awards for excellence, to identify STPs and facilitate new ones, and to encourage efficiency, and coordination of transportation programs that serve seniors. Membership is free. All Exchange members:

must commit to provide information and ideas to other members;
must be willing to participate in the STP Exchange program and its activities;
must be located in North America; and
all transportation services or programs must provide transportation (or plan to provide) transportation to older adults.

How Can You Join?

Just Complete the STP Exchange Inquiry below and press Submit Query. Please note that you must have a completed inquiry in order to participate in future STAR Awards. If you are a professional, please complete the contact information section and items 23, 24, and 25 (Please note that only programs can participate in STAR Awards)

Name of Program/Organization:
Street Address:
City:	State:	Zip (5 to 9 digits, no dashes):
Telephone (ex 3022221144):	Fax:
Website:	Email:
Contact Name:

II. General Program Features (Please Report 2007 Facts)

1. Year transportation program started:

2. Type of organization:(check only one)

government profit nonprofit other

3. Name of program/service sponsor (organization) if any?

4. Area Served:
a. Geographic area served: (check all that apply)

urban suburban rural

b. Transportation service area: (check all that apply)

city
county
sq. mile area (please specify)
other (please specify)
no jurisdiction

III. General Service Information (Please Report 2007 Facts)

5. Range of services: (check only one)
organization provides transportation only
organization provides a menu of services, including transportation
other please specify

6. Availability of transportation: (check all that apply)
Time of day: daytime evenings nights 24/7
Day of week: weekdays Saturday Sunday

7. Types of assistance: (check all that apply)
curb-to-curb service
door-to-door service
door-through-door service
stay at destination
escort service
other (please specify)

IV. Budget Features (Please Report 2007 Facts)
8. Range of annual transportation budget: (check only one)

$0 - $49,999
$50,000 - $99,999
$100,000 - $199,999
$200,000 - $499,999
$500,000+

Specific budget: please specify

9. Breakdown of 2007 transportation program budget by funding sources:
(check all that apply and total should = 100%)
For the following items make two entries each; one for the type of funding, and another for the percentage.
% grants
% rider fees
% tax revenue
% rider donations
% other please specify

10. Fee structure: (check all that apply)
no rider fees
flat rate
sliding scale
rider donations
mileage rate
other please specify

V. Rider/Destination Features (Please Report 2007 Facts)
11. Type(s) of riders served: (check all that apply)
seniors
people with disabilities
people with dementia
children
other (please specify)

12. Total number of riders served in 2007:

13. Do you allow your riders to make multiple stops in single trips?
yes no

14. How do you count the number of rides?
one-way round-trip other (please specify)

15. Total number of rides provided in 2007:
one-way: round-trip:

16. Top three destinations of senior riders: (check no more than 3)
medical services (non-emergency)
shopping
social services
nutrition services
religious activities
volunteer activities
recreational activities
social visits
other (please specify)

VI. Driver/Vehicle Information (Please Report 2007 Facts)

17. Total number and types of drivers in 2007:
volunteer drivers #
paid drivers #

18. Vehicle(s) used by programs: (check all that apply)
vehicles belonging to or leased by program
vehicles belonging to drivers
vehicles belonging to riders
other(please specify)

19. Number of vehicles:

20. For the following items make two entries each; one for the type of vehicle and another for the percentage.:
autos #
vans #
taxis #
buses #
other # (please also specify the type)

VII. Community Relationships

21. Primary relationships with human services: (check all that apply)
area agency on aging
faith-based organization
senior center/recreation program
social service program
community volunteer program
health service providers
assisted living or retirement community
adult day service program
other please specify
no service relationships

22. Primary relationships with transportation services: (check all that apply)
public transportation agency
ADA paratransit agency
paratransit/demand response
local DMV
community taxi service
private transportation service
other (please specify)
no service relationships

VIII. What Can I Give and What Can I Get?

23.How can your program’s involvement benefit the Exchange? (please give one or several examples if at all possible)

24.How can involvement in the Exchange benefit your program? (please give one or several examples if at all possible)

25. Please describe a distinctive organizational feature or activity that you think others
would want to know about. (please specify)

Please check below if you want your organization’s information posted on the STP Exchange website.