494 Corridor Commission - Commute Planner

It's Easy to Enter and Win...
Carpool or Vanpool at least once during the month of October.

Carpooling or Vanpooling can include sharing a ride with a spouse, family member, friend or co-worker.

Receive a list of people interested in ridesharing who have a similar commute by completing the form below. Request a list now through October and receive a 10 dollar gas gift card! (while supplies last)

Grand Prize: Pledge and you will be eligible to win an iPhone!

By submitting this form, I pledge to try a better way of commuting to work during Rideshare to Work Month. To be eligible for prizes, I understand that my pledge form must be received by October 31.

How do you currently commute to work, at least three days per week (please check one)
Drive Alone	Bus	Carpool	Vanpool
Bike	Light Rail	Walk	Telecommute

Home Information
First Name	MI	Last Name

Home Address

Apt

City

State

Zipcode

Home Phone

*Email *required

Cell Phone

Work Information
Company Name
Street Address		Suite/Mail Stop
City	State	Zipcode
Work Phone Ext.

What do you pledge to do during Rideshare to Work Month?

Carpool Vanpool

How often will you do this during Rideshare to Work Month?

Once Once a week 2-4 days a week 5 days a week

Please send me the following information to help me get started.

A list of people interested in car- or vanpooling Vanpool information Park & Ride Map

I start work at:
Hour	Minute	AM or PM
:
I finish work at:
Hour	Minute	AM or PM
:

Please answer the following questions only if you are interested in receiving a list of people who want to share a ride to work.

I prefer to be a:
Driver Rider Either

My hours are flexible by more than 30 minutes on the start & finish times:
Yes No

Privacy Protection Statement: Tennessen Warning (Data Privacy Act)
1. You will be asked to provide certain information on this form for the purpose of providing you and like applicants with rideshare services. 2. Participation in the Metro Commuter Services program is strictly voluntary, and you are not required by law to furnish any of the information requested on the form. 3. The following information requested on this form is classified as private data under the Minnesota Government Data Practices Act: (a) your residential address and telephone number; (b) your beginning and ending hours; (c) your current mode of commuting to and from work; and (d) the type of rideshare service information you have requested. All other information you provide is considered public data and is accessible by any person for any reason. 4. You should know that any of the information you provide, whether classified as private or public, will be provided to certain other entities and individuals in order to supply you with the requested rideshare services. These entities and individuals include other agencies or governmental units, employers that are participating in the matching of information of rideshare applicants, and other matched rideshare applicants. In order to provide you with rideshare service(s), match lists containing your name, address, employer, telephone number(s) of your choice, working hours and rideshare preference may be sent to any of the above entities or individuals. 5. The only consequences of not furnishing all of the information on this form are: 1) the rideshare program will be denied data to be used for statistical evaluation, and 2) the rideshare program's ability to supply you with the requested services may be restricted. 6. The information provided by you on this form will be solely and exclusively for providing you and other applicants with rideshare service. Information submitted on this form will be used for providing requested materials and/or ridematching purposes only.

By pressing Submit, I verify that the above information is true and correct, and that I have read the Tennessen Warning. * Required

Yes, I agree.

No, I do not agree.